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Prosthetic joint infection: Epidemiology, clinical manifestations, and diagnosis

Elie Berbari, MD, FIDSA
Larry M Baddour, MD, FIDSA, FAHA
Section Editor
Daniel J Sexton, MD
Deputy Editor
Elinor L Baron, MD, DTMH


The epidemiology, clinical manifestations, microbiology, and diagnosis of prosthetic joint infections (PJIs) will be reviewed here. Infections associated with other implanted orthopedic devices, such as pins and rods, will not be specifically discussed, but similar principles may apply [1].

Treatment and prevention of PJIs are discussed separately. (See "Prosthetic joint infection: Treatment" and "Prevention of prosthetic joint and other types of orthopedic hardware infection".)


Nearly one million total hip arthroplasties (THAs) or total knee arthroplasties (TKAs) are performed in the United States each year. It is estimated that, by 2030, more than four million THAs or TKAs will be performed in the United States annually [2].

The rate of prosthetic joint infection (PJI) in most centers ranges between 0.5 to 1.0 percent for hip replacements, 0.5 to 2 percent for knee replacements, and less than 1 percent for shoulder replacements [1,3-7]. The risk of prosthetic joint infection is greater for knee arthroplasty than hip arthroplasty.

In a study involving over 69,000 patients undergoing elective total knee arthroplasty followed longitudinally from 1997 to 2006, the rate of infection was highest during the first two years following surgery (incidence 1.5 percent). The rate of infection 2 to 10 years after joint replacement was 0.5 percent [8]. Depending on the type of surgical procedure, causative pathogen, and comorbid conditions, upwards of 10 to 20 percent of patients experience recurrent PJI [9,10].

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Literature review current through: Dec 2017. | This topic last updated: Nov 30, 2017.
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