Infection of articular prosthesis

"Our years of experience in treating these patients in a multidisciplinary way puts us in a 90% cure rate of early infections".


In Spain approximately 30,000 arthroplasties are performed each year, placement of a joint prosthesis.

Although it is a rare complication, the infection of the joint prosthesis occurs in only 2-4% of prostheses that are placed, is one of the problems most feared by orthopedic surgeons.

These infections are usually caused by the patient's own bacteria (Pseudomonas and Staphylococcus are the bacteria that most frequently form biofilms).

The bacteria adhere to the joint surface, begin to multiply and produce a gelatinous matrix that serves as protection against antibiotics.

What are the symptoms of a prosthetic infection?

Early infections occur between the first and third month after placing the prosthesis. In those cases, the patient presents fever, inflammation of the area, pain and even suppuration of the wound and lack of healing. These signs make the suspicion of infection very evident and make it easier to start the appropriate treatment.

However, in more than 50% of the cases the infections are late. They occur after three months since the prosthesis was implanted and the only symptom patients refer to is pain.

The pain can be related only to the loosening of the prosthesis, without any associated infection, but on other occasions the pain is caused by an infection of the surface of the joint prosthesis.

These infections are usually caused by the patient's own bacteria, which adhere to the surface of the prosthesis. It begins to multiply and produce a gelatinous substance that protects them, called biofilm. This biofilm is resistant to antibiotics, which makes it difficult for them to be effective.

Imagen del infográfico sobre las infecciones asociadas a biofilms

Device infections associated with biofilms (available in spanish)

The most common symptoms are:

  • Pain.
  • Lack of functionality of the joint.
  • Fever.

Do you have any of these symptoms?

You may have an infection in your joint replacement

How is a prosthesis infection diagnosed?

Early and accurate diagnosis is critical to greater treatment success. The multidisciplinary approach by a team composed of traumatologists, infectologists, microbiologists specialized in joint infections, radiologists, rehabilitators and specialists in Nuclear Medicine facilitates a rapid diagnosis and allows the implementation of optimal treatment from the beginning.

PET (Positron Emission Tomography) is a diagnostic imaging technique with great capacity for detecting infection associated with joint prostheses.  In addition, it offers the advantage of scanning the entire body in a non-invasive manner.

Glucose is the most commonly used PET imaging tracer, but we are investigating new tracers, such as fluoro-sorbitol and fluoro-PABA, that are specific to certain germs. These tracers will make it possible not only to locate bacterial infections more precisely, but also to distinguish the type of bacteria and monitor the response to antibiotic treatment.

We have a Bacterial Biofilm Laboratory in which we are continuously investigating new ways to improve the diagnosis and treatment of these infections.

How is joint replacement infection treated?

The vast majority of prosthetic infections require a combined medical and surgical treatment with tissue cleaning and debridement of the area, with removal of prosthesis and specific antibiotics until the infection is cured.

The objectives of the treatment of the infections of the articular prosthesis are, in order of priority, to remove the pain to the patient, to obtain an improvement in the functionality of the articulation and in third place, to manage to eradicate the microorganism causing the infection.

The treatment of these infections must be multidisciplinary. The orthopedic surgeon who placed the prosthesis must work with specialists in infectious diseases and microbiologists, experts in this type of infections.

Rehabilitation specialists are also fundamental to recover the mobility of the articulation and that the degree of functionality of the patient is as optimal as possible.

One of the main lines of research in the area of infectious diseases is the study and treatment of these infections associated with joint prostheses.

We have a Bacterial Biofilm Laboratory whose objective is to develop new diagnostic and therapeutic strategies.

We are looking for new molecular diagnostic and imaging techniques to achieve an early diagnosis of these infections and increase the chances of success.

We are evaluating the efficacy of new antibiotic drugs that allow the treatment of these multi-resistant microorganisms, as well as other non-antibiotic substances and the use of electromagnetic waves to facilitate the efficacy of the antibiotics.

Where do we treat it?


The Infectious Diseases Service
of the Clínica Universidad de Navarra

This area works on the diagnosis and treatment of diseases produced by an infectious agent, which can be bacteria, virus, fungus and protozoa. Infections affect people by causing very different processes that can be located in any tissue of the human body, so it requires a specific approach.

This area carries out its activity on three fronts: care work, focused on the diagnosis and treatment of infectious diseases; teaching, with training of medical students, resident doctors and nurses; and research vocation, through the development of clinical and laboratory studies.

Organized in care units

  • Infections associated with biomaterials.
  • Nosocomial infections (multi-resistance).
  • Infections in immunosuppressed patients.
  • Community infection.
  • Traveler's medicine.
  • Prudent use and optimization program of anti-infective therapy.
  • Control of infection by multi-resistant microorganisms.
Imagen de la fachada de consultas de la sede en Pamplona de la Clínica Universidad de Navarra

Why at the Clinica?

  • We perform the traveler's assessment and analytical tests in less than 24 hours.
  • Second opinion consultation when the infection has not yet been resolved.
  • We ensure the prudent use of antibiotics.