Infection

Infection after hip arthroscopy is uncommon, but deep infection and septic arthritis require urgent assessment and treatment. A superficial portal or incisional problem should be distinguished from a suspected deep joint infection. 1,2

Risk and prevention

Reported rates vary with definition and data source. A systematic review of 36,761 hips reported infection in 0.2% overall and deep infection in 0.02%, but the underlying studies were heterogeneous and likely under-report events. A recent database study of 75,577 hip arthroscopies reported 90-day surgical-site infection in 0.31%; BMI ≥35 kg/m² and several coded comorbidities were associated with infection. These are associations, not a patient-specific prediction rule. 1,2

Optimize modifiable risk where possible, including tobacco cessation, glycemic and medical optimization, skin preparation, appropriate prophylactic antibiotics, sterile technique, and careful wound care. Ask specifically about recent ipsilateral injection and its timing. Retrospective data associate injection within three months with higher postoperative infection rates, although injectate, technique, and indication are incompletely captured; follow local institutional and surgeon policy. 3

Recognize and investigate

Concern	Action
Mild portal erythema or drainage without systemic illness	Examine closely, document progression, obtain cultures if purulent/draining, and maintain a low threshold to escalate if deep pain or systemic features develop.
Increasing deep hip pain, pain with passive ROM, fever/chills, wound drainage, inability to progress, or unexplained inflammatory response	Urgent assessment. CBC, CRP and ESR support trend assessment but do not rule infection in or out alone. Obtain blood cultures if systemic illness is present.
Suspected septic joint	Urgent image-guided aspiration when feasible: send synovial fluid for cell count/differential, Gram stain, and culture. Obtain samples before antibiotics if the patient is stable; do not delay resuscitation and empiric antibiotics in sepsis.

Treat deep infection as an emergency

In suspected or confirmed septic arthritis after arthroscopy, involve the treating surgeon early and coordinate with infectious diseases/microbiology. Operative irrigation and debridement with multiple deep cultures is commonly required when deep infection is suspected or confirmed. Antibiotics should be culture-directed and tailored to clinical status, organism, source control, and local guidance; this chapter deliberately does not prescribe a fixed regimen or duration. 4,5

Worsening deep pain, systemic symptoms, painful passive motion, or failure to progress should not be attributed to routine postoperative discomfort.

Management sequence:

Red flags require urgent assessment with CBC, CRP, and ESR, with blood cultures when systemic illness is present. If the patient is stable and deep infection is plausible, obtain aspiration before antibiotics when feasible. Sepsis requires immediate resuscitation and empiric antibiotics, followed by urgent surgical source control and culture-directed therapy.

References