Knee replacement infection: Symptoms and risk factors (2022)

A knee replacement infection may develop after a person has had an operation to replace their knee joint. What are the symptoms of a knee replacement infection and who is at most risk of getting one?

Knee replacement surgery, also known as knee arthroplasty, is one of the most common types of elective surgery. It is estimated that by 2030 as many as 3.48 million knee replacements will take place in the United States.

Knee replacement surgery may be necessary if a person has ongoing severe knee pain or swelling that affects their ability to carry out daily activities.

Most people are free from pain and regain their mobility after surgery. However, some people who have knee replacement surgery may develop an infection.

This article explores the signs, causes, risk factors, and treatments for a knee replacement infection. It also considers how to prevent knee replacement infections from happening.

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A knee replacement infection may develop in the wound after surgery. It may also occur around the artificial implant that is used to replace the knee joint. Harmful bacteria entering the wound usually cause the infection.

A knee replacement infection can occur any time after surgery. For example:

(Video) Infected Total Knee Replacement. A dreaded complication. What you need to know.

  • during the hospital stay after surgery
  • when a person goes home after surgery
  • months or even years after surgery

According to the American Academy of Orthopaedic Surgeons, only one in every 100 people who have a hip or knee replacement will develop an infection.

The following are normal after knee replacement surgery:

  • mild swelling in knee or ankle
  • some redness around the incision or knee
  • warmth around incision or knee

These post-surgery symptoms do not indicate an infection and should not be a cause for concern. These symptoms should get better over time.

If post-surgery symptoms get worse rather than better over time, this may be a sign of infection.

A person who experiences one or more of the following symptoms may have a knee replacement infection:

  • inability to walk without pain after the point at which the doctor said walking should be pain-free
  • increasing pain and stiffness in the artificial joint
  • warmth, redness, and tenderness around the incision or the whole knee
  • grey liquid draining from the incision, especially if it smells bad
  • a fever above 100°F (37.8°C)
  • chills or night sweats
  • fatigue

Causes

(Video) Prosthetic Joint Infection [Hot Topic]

After knee replacement surgery, bacteria might enter a person’s body through the wound where the surgical incision was made. If bacteria reach a person’s new artificial knee joint, they may multiply and cause an infection.

Some bacteria are harmless, such as those that occur naturally in the stomach, while others may harm a person and cause an infection. A person’s immune system usually kills any harmful bacteria that get into the bloodstream.

When a person has a knee replacement, their knee joint is replaced with an artificial joint made of metal and plastic. Because these materials are not organic, it is harder for the body to kill bacteria on them.

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Anyone who has a knee replacement can develop an infection after surgery, but some groups are at a greater risk of infection. These include people who:

  • have immune deficiencies, such as HIV or lymphoma
  • have diabetes
  • have poor circulation in their hands or feet
  • are using treatments that suppress the immune system, such as chemotherapy or corticosteroids
  • have frequent urinary tract infections
  • have a BMI of over 50
  • have dental problems
  • have dermatitis or psoriasis
  • have rheumatoid arthritis
  • smoke
  • have had knee surgery before
  • have had an infection in their artificial knee before

Diagnosis

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A doctor may be able to diagnose a knee replacement infection with a visual examination.

Sometimes, the doctor may need to investigate the type of bacteria that is causing infection using one or several of the following tests:

  • Blood test: This can help measure inflammation in the body, which can indicate an infection.
  • Imaging test: This can help determine if there is an infection in the artificial joint. Examples of imaging tests include X-rays, computed tomography (CT) scans, magnetic resonance imaging (MRI), or bone scans.
  • Joint aspiration: Fluid is drawn from the knee and tested for bacteria and white blood cells. A large number of white blood cells is a sign the body is fighting an infection.

There is a range of treatments for a knee replacement infection, including both nonsurgical and surgical procedures.

Nonsurgical treatment

Some knee replacement infections are superficial, which means that the infection has reached the skin and tissue around the joint but does not affect the artificial joint itself.

A superficial knee replacement infection may be treated with oral or intravenous (IV) antibiotics.

Surgical treatment

If a knee replacement infection goes deeper than the skin and tissue around a joint, it may need to be treated surgically. Surgical treatment options include:

  • Debridement: This is a surgical washout of the joint. Any contaminated soft tissue is removed, and the artificial joint is cleaned. Plastic liners or spacers in the artificial joint may be replaced. The doctor will prescribe IV antibiotics to be taken after surgery.
  • Staged surgery: This involves a series of surgeries to remove and replace the artificial joint. This may be necessary if the infection has developed months or years after the original knee replacement.

The different stages of staged surgery typically include:

  • Removal of the artificial joint: When the infection is deep and long-lasting, the artificial joint will need to be removed.
  • Joint washout: Washing helps get rid of infected soft tissue in the joint.
  • Placement of antibiotic spacer: This helps maintain joint space and keeps the joint aligned while the infection is treated.
  • IV antibiotics: These help kill the infection. The doctor may prescribe a course that lasts up to 6 weeks.
  • New knee replacement surgery: Once the infection has been treated, another knee replacement surgery can be carried out. The doctor will remove the antibiotic spacer and give the person a new artificial knee joint.

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Before and during knee replacement surgery, the following steps may help reduce the risk of infection:

  • Using prophylactic antibiotics: According to a 2013 review, preventive medicines may help reduce the risk of knee replacement infection.
  • Using antibiotics: These should be given immediately before, during, and after surgery for up to 24 hours.
  • Keeping operation time short: A short operation time reduces the length of time the wound is open and vulnerable to infection.
  • Reducing the number of people present: Limiting the number of people and limiting the number of times they come and go may reduce the bacteria in the room and decrease the risk of infection.
  • Using sterile equipment: The theatre, instruments, and artificial joint should all be sterilized.
  • Screening for bacteria in the nose: If a person has certain types of harmful bacteria in their nasal passage, they may increase the risk of infection. Some hospitals screen for these bacteria before operating. If harmful bacteria are found, the person will be given an antibacterial ointment to use. Some medical centers will routinely decolonize nasal passages with mupirocin several days before surgery.
  • Washing with chlorhexidine: This may help reduce the number of harmful bacteria on the skin before surgery.

After a person has had knee replacement surgery, the following measures may help reduce the risk of infection:

  • following the doctor’s advice on how to treat the wound
  • clean and cover cuts, wounds, or burns as soon as they happen
  • maintain dental hygiene, as infections in the mouth may spread to the artificial joint
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Although they may require surgery, knee replacement infections are treatable. Once a person has received proper treatment, the pain and swelling around the joint should improve, and they will regain movement.

Following pre- and post-surgery preventative measures will reduce the risk of further infection.

FAQs

How do you know if you have an infection in an artificial joint? ›

Artificial joint infection symptoms — People who develop infections immediately after joint replacement surgery typically have pain, redness, and swelling at the joint or drainage from the wound.

What happens if a total knee replacement gets infected? ›

Surgical treatment

If a knee replacement infection goes deeper than the skin and tissue around a joint, it may need to be treated surgically. Surgical treatment options include: Debridement: This is a surgical washout of the joint. Any contaminated soft tissue is removed, and the artificial joint is cleaned.

What happens when you get an infection in your knee replacement? ›

The knee replacement implants may become loose if the infection has been present for a long time. In these cases, the implants often need to be removed and the infection treated.

What are 3 signs of joint infection? ›

Different types of bacteria, viruses, and fungi can infect a joint. Symptoms include fever, joint pain, swelling, redness, and warmth.

What does a knee infection feel like? ›

Symptoms of Knee Infection

The most common symptom is knee pain and inability to move your knee joint. Other symptoms include: Fever and chills. Swelling around your knee joint.

What percentage of knee replacements get infected? ›

Knee replacement surgery is a common surgery that doesn't present complications for most people. In less than 1 percent of joint replacement surgeries, an infection occurs around the area of the artificial implant.

How is a knee infection diagnosed? ›

Knee infections are diagnosed by testing the fluid in your knee. Aspiration of the fluid is performed by inserting a needle into the affected joint space. The fluid that's removed is tested for white blood cells, viruses, fungi, and bacteria.

Can a knee infection lead to amputation? ›

Prevalence of amputation in terms of failure or complications after TKR procedures was estimated between 0.1-10% in different studies , with 5.1% amputation rate in infected TKR and 0.025% amputation rate in primary TKR as a result of infection in our review. Deep infection was the main cause of amputation.

Can you get an infection in a knee replacement years later? ›

Infections in the incision usually occur within a few days of surgery, while the skin is healing. However, joint infections can occur days to years later. It is important to report any increase in pain in your artificial joint, especially any signs of an infection.

How common is the knee infection after surgery? ›

Background. Approximately 340,000 knee replacements are performed each year in the USA and UK. Around 1% of patients who have had knee replacement develop deep infection around the prosthesis: periprosthetic knee infection. Treatment often requires a combination of one or more major operations and antibiotic therapy.

How long after surgery can you get an infection? ›

Most surgical wound infections show up within the first 30 days after surgery. Surgical wound infections may have pus draining from them and can be red, painful or hot to touch. You might have a fever and feel sick.

What is the most commonly reported problem after knee replacement surgery? ›

Knee Stiffness

One of the most common problems people experience after knee replacement is a stiff knee joint. Often these symptoms can cause difficulty with normal activities including going down stairs, sitting in a chair, or getting out of a car. Management of a stiff knee joint after replacement can be a challenge.

What does an infected knee look like? ›

It often has a yellow or white center and a central head. Sometimes an infected area is surrounded by an area of redness and warmth, known as cellulitis. Pus and other fluids may drain from the affected area. Some people also experience a fever.

What percentage of total knee replacements get infected? ›

Background. Approximately 340,000 knee replacements are performed each year in the USA and UK. Around 1% of patients who have had knee replacement develop deep infection around the prosthesis: periprosthetic knee infection. Treatment often requires a combination of one or more major operations and antibiotic therapy.

How long after TKR can you get an infection? ›

Everyone who has a knee replaced is at risk for a deep infection. Most infections occur in the first two years after surgery. This is when 60 to 70 percent of prosthetic joint infections occur. That said, infections can develop at any time after surgery.

Can you get an infection in a knee replacement years later? ›

Infections in the incision usually occur within a few days of surgery, while the skin is healing. However, joint infections can occur days to years later. It is important to report any increase in pain in your artificial joint, especially any signs of an infection.

What are 3 signs of joint infection? ›

Different types of bacteria, viruses, and fungi can infect a joint. Symptoms include fever, joint pain, swelling, redness, and warmth.

Can knee infection go away on its own? ›

If the infection is diagnosed and treated promptly, there is usually no lasting joint damage. If the infection is not treated early, permanent joint damage may result. Bacterial and fungal infections are usually treated with medication. A viral infection will generally go away on its own.

What is the most commonly reported problem after knee replacement surgery? ›

Knee Stiffness

One of the most common problems people experience after knee replacement is a stiff knee joint. Often these symptoms can cause difficulty with normal activities including going down stairs, sitting in a chair, or getting out of a car. Management of a stiff knee joint after replacement can be a challenge.

Can a knee infection lead to amputation? ›

Prevalence of amputation in terms of failure or complications after TKR procedures was estimated between 0.1-10% in different studies , with 5.1% amputation rate in infected TKR and 0.025% amputation rate in primary TKR as a result of infection in our review. Deep infection was the main cause of amputation.

How do I know if my body is rejecting my knee replacement? ›

What are the signs of knee replacement failure? The most common symptoms of a failed knee implant are pain, decrease in joint function, knee instability, and swelling or stiffness in the knee joint.

How do you get a bacterial infection in your knee? ›

The possible risk factors that may cause a knee infection include:
  1. Joint conditions such as rheumatoid arthritis.
  2. Immune-suppressing medications.
  3. Surgery involving repair of torn cartilage or tendon.
  4. Artificial joints.
  5. Diabetes.
  6. A deep cut which may expose tissue or bone to bacteria.

What antibiotics are used for a knee infection? ›

Moreover, 91.0% of the patients received antibiotics with good oral bioavailability, such as quinolone, rifampin, clindamycin, and trimethoprim–sulfamethoxazole, and 51.1% received the recommended combination of rifampin and quinolone.

Can you get an infection 2 years after surgery? ›

From the Departments of Surgery (Drs Davis, Wolff, and Dineen and Mr Cunningham) and Medicine (Dr Drusin), Cornell University Medical Center, New York. A small number of patients manifest wound infections several months to several years after their operations.

Can a tooth infection affect a knee replacement? ›

Sixty-two total knee arthroplasties with late infections (greater than 6 months after their procedure) were identified, and of these, seven infections were associated strongly with a dental procedure temporally and bacteriologically.

What is the lifespan of a total knee replacement? ›

In 85% to 90% of people who have a total knee replacement, the knee implants used will last about 15 to 20 years. This means that some patients who have a knee replacement at a younger age may eventually need a second operation to clean the bone surfaces and refixate the implants.

Videos

1. Prosthetic Joint Infection.mpg
(Orthopaedic Principles)
2. Total Knee Replacement (TKR) Pain: Symptoms, Causes, Risk Factors, Healing Cycle & Treatment
(Dr. Joseph Jacobs DPT)
3. Surgical Site Infections (SSI) Made Easy - A Surgeon's Guide
(citizensurgeon)
4. Dr. K Answers: Infection in Knee Replacements, pt. 2 of eOrthopod.tv TKR Series
(DTCHealthcom)
5. Prosthetic Joint Infection -- Won Hee So, PharmD
(IDPodcasts)
6. Common bone & joint infection in children explained by Dr Gourav Jandial
(CK Birla Hospital)

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