Last reviewed: September 29, 2026

It is uncommon. About 1 in 70 people develop an infection of the new hip within 15 years.

That figure comes from about 100,000 hip replacements in Canada, in people 55 and older. Most infections appear in the first two years. A few appear many years later, sometimes when bacteria from an infection elsewhere in the body travel through the blood to the joint. One large study found the rate did not change over 15 years. Another, of hips and knees together, found early infections becoming more common.

Obesity has the strongest evidence as a risk factor. Diabetes, smoking, anemia, poor nutrition, rheumatoid or other inflammatory arthritis, and heart, kidney or liver disease are also linked to more infection. So is a previous infection in a joint. Men have more infections than women. A hip replaced after a broken hip had more infections than one replaced for arthritis. A large hip study found more infection in younger people, but studies are mixed on age.

A weakened immune system may also raise the risk. People with sickle cell disease had more infections after hip replacement than people without it, especially with the most severe form of the disease. Chemotherapy started in the year after a hip replacement was linked to more infection in the years that followed. In people with rheumatoid arthritis, steroid pills were linked to more infection, more so at higher doses. The different biologic drugs carried similar risks to one another. Some record studies found more infection after an organ transplant, but not all did. In people with HIV, pooled hip studies found infection rates similar to those of people without HIV. Where it was measured, most had the virus well controlled.

These are links from records, not proof of cause, and most of the evidence is rated low quality.

According to the American Academy of Orthopaedic Surgeons, antibiotics given at the time of surgery and chlorhexidine antiseptic wipes used on the skin before surgery lower the risk, on limited evidence. When the hip is fixed with bone cement, the same guideline says antibiotics mixed into the cement may lower the risk. People who carry MRSA in the nose may be treated with a nose ointment before surgery. In pooled studies, the anterior approach did not carry more infection than other approaches. Across all kinds of surgery, shaving the skin with a razor was linked to more infections than clipping the hair or leaving it alone. Whether improving weight, blood sugar or smoking before surgery lowers the risk is not yet clear.

When a hip replacement does become infected, it usually needs more surgery, and function and quality of life are often worse afterward.

In general:

  • Tell your surgeon about diabetes, sickle cell disease, HIV, a transplant, cancer treatment, any past joint infection, or medicines that weaken the immune system.
  • Ask how your arthritis or transplant medicines will be handled around surgery.
  • Ask your surgeon before shaving near your hip in the days before surgery.
  • A hip that becomes more painful, swollen, red or warm, or starts draining, needs to be seen promptly, even years after surgery.

Drafted with AI assistance from published sources, reviewed and edited by Babak Sheikh, MD.

Sources:

This is general information about what published research shows. It is not medical advice and it is not about your situation. Reading it does not create a doctor-patient relationship with me. I am a retired orthopedic surgeon and I do not see patients. Talk with your own doctor before changing anything about your care. If something feels suddenly or seriously wrong, get medical care promptly rather than waiting.

This page is provided as is. I make no guarantee that it is accurate, complete or current, and medical evidence changes. Use of it is at your own risk.

Published by Clinical Evidence Media LLC. Full disclaimer and how these answers are researched: Disclaimer and how these answers are made