Educational draft · awaiting clinical reviewUse Rapid for revision, not patient-care decisions. Check current national and local guidance and the BNF or BNFC before acting.
2 min synopsisUK scopeSources checked 27 Aug 2026Clinical review pending
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Sepsis, wound breakdown or threatened limb
Shock, rapidly spreading infection, acute severe prosthetic-joint pain, purulent drainage, neurovascular compromise or wound dehiscence requires urgent source control.
Action: Use ABCDE, take blood cultures, contact the implant orthopaedic team and microbiology immediately, start intravenous treatment if unstable and arrange urgent operative washout and multiple deep samples.
Synopsis
Recognise acute and indolent prosthetic-joint infection, protect microbiological yield, obtain multiple deep samples and coordinate biofilm-active therapy with an appropriate implant surgical strategy.
Prosthetic-joint infection is a biofilm infection involving an arthroplasty surface and surrounding tissue; it cannot be managed as simple cellulitis or native-joint sepsis.
Classify timing and symptom duration: early postoperative, acute haematogenous and chronic indolent presentations have different surgical opportunities.
In a stable patient, protect culture yield by withholding empirical antibiotics until aspiration or operative deep samples have been obtained.
Key red flags
Hypotension, confusion, tachypnoea or rising lactate indicates prosthetic-joint infection with sepsis.
Early postoperative failure
Persistent drainage, wound breakdown, new erythema, effusion, escalating pain or fever soon after arthroplasty suggests early implant infection.
Prosthetic-joint infection is suspected but the patient has no sepsis, wound catastrophe or neurovascular emergency.
Contact the arthroplasty or implant surgeon early and document implant type, operation date, revisions, symptom duration, wound history and previous antibiotics.
Obtain radiographs, CRP and ESR and arrange image-guided aspiration under the local prosthetic-joint protocol.
DAIRDebride and retain selectively
Infection is acute, the implant is stable, soft tissues are salvageable and symptom duration and organism make retention plausible.
Key medicines
Empirical prosthetic-joint intravenous regimenGive the exact local implant-infection regimen after multiple deep samples, adjusted for timing, previous cultures, allergy, renal function and MRSA and Gram-negative risk.
Flucloxacillin for methicillin-susceptible staphylococciGive 2 g intravenously every four to six hours when directed, using the exact interval in the local bone-and-joint infection protocol.
National guidance is shown before implementation-dependent detail. Typical adult dose examples remain subject to patient factors, contraindications and the live BNF or specialist protocol. Source check completed 27 Aug 2026; clinical approval remains outstanding.