Clinical practice. Infection associated with prosthetic joints

N Engl J Med. 2009 Aug 20;361(8):787-94. doi: 10.1056/NEJMcp0905029.


A 62-year-old woman with osteoarthritis presents with a 7-month history of progressively worsening left hip pain radiating to the groin, 8 months after undergoing total left-hip arthroplasty. The pain has not responded to nonsteroidal antiinflammatory drugs. Physical examination reveals a sinus tract overlying her left hip. Her leukocyte count is 8000 per cubic millimeter, and the C-reactive protein (CRP) level is 15.5 mg per liter. A radiograph shows loosening of the prosthesis at the bone–cement interface. Synovial-fluid aspirate shows 15×103 cells per cubic millimeter (89% neutrophils); cultures of an aspirate from the hip grow Staphylococcus epidermidis. How should her case be managed?

Publication types

  • Research Support, N.I.H., Extramural
  • Review

MeSH terms

  • Anti-Bacterial Agents / therapeutic use
  • Arthroplasty, Replacement, Hip*
  • C-Reactive Protein / analysis
  • Combined Modality Therapy
  • Debridement
  • Female
  • Hip Prosthesis / adverse effects*
  • Humans
  • Middle Aged
  • Prosthesis Failure
  • Prosthesis-Related Infections / diagnosis
  • Prosthesis-Related Infections / microbiology
  • Prosthesis-Related Infections / prevention & control
  • Prosthesis-Related Infections / therapy*
  • Staphylococcal Infections / diagnosis
  • Staphylococcal Infections / drug therapy
  • Staphylococcal Infections / therapy*
  • Staphylococcus epidermidis / isolation & purification*


  • Anti-Bacterial Agents
  • C-Reactive Protein