When a joint replacement becomes painful and infection is possible, starting antibiotics before joint aspiration can suppress culture growth and leave the diagnosis uncertain for months.
Unless the patient is septic, take blood markers and aspirate first, then start treatment once samples are taken.
- Check CRP and ESR in any painful or failing joint replacement
- Aspirate the joint for cell count and culture before giving antibiotics if the patient is stable
- Avoid oral antibiotics for a 'red wound' without a diagnosis
- Refer suspected periprosthetic infection early to the arthroplasty team
Why it matters
Empirical antibiotics given too early are a common reason periprosthetic infection goes unconfirmed.
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