What is the approach to suspected prosthetic joint infection in a patient presenting with acute joint pain and warmth?

• A. Imaging, joint aspiration for culture, possible surgical management, and empiric antibiotics covering Staph and Gram-negatives; tailor therapy to culture results.
• B. Imaging only.
• C. Immediate joint replacement.
• D. No antibiotics initially.

Answer: (A)

Suspected prosthetic joint infection requires urgent, systematic action to confirm the infection, identify the bug, and control the source. The best initial approach combines imaging to assess the prosthesis and surrounding tissues with obtaining synovial fluid through joint aspiration for culture and Gram stain. This gives the actual pathogen and guides tailored therapy. Because Staphylococcus species (including MRSA) and Gram-negative organisms are the most common culprits, starting broad-spectrum antibiotics that cover both groups is appropriate while awaiting culture results. Once culture and susceptibility data are available, antibiotics can be narrowed to target the specific organism. Surgical management may be needed for source control, with plans ranging from debridement with implant retention in select early infections to one- or two-stage exchange procedures for established infections. This sequence—imaging, aspiration for culture, empiric broad-spectrum antibiotics, and subsequent tailoring with surgical planning—captures the correct approach.