Bone and joint infection management
The combined surgical and antibiotic treatment used to clear an infection in a bone, a joint, or around a joint replacement, and to protect long-term function.
✓ Medically reviewed by a GMC-registered consultant · last reviewed September 2026 · next review September 2027 · how we review
In short
- These infections usually need both surgery (to drain or clean the area) and a long antibiotic course.
- Antibiotics often run for about six weeks or longer; finishing the whole course is essential even when you feel better.
- Recent evidence (the UK OVIVA trial) shows well-chosen tablets can work as well as drips for many people once the infection is controlled.
- Infections around joint replacements can be hard to clear and sometimes need more than one operation - this should be discussed honestly.
A plain-English summary. The detail — including risks and recovery — is below.
At a glance
A general guide. Your specialist will give you advice for your situation.
Clears or controls the infection and reduces the chance of it spreading
Antibiotics alone are not enough when there is pus, a collection or dead bone that needs surgical drainage or removal.
After any surgery and the start of antibiotics, pain and fever begin to settle. You are monitored closely with blood tests and reviews.
A named infection and surgical team with a clear emergency contact route.
After any surgery and the start of antibiotics, pain and fever begin to settle. You are monitored closely with...
Once stable, many people switch from drips to tablets, or move to home intravenous antibiotics through an OPAT...
Most courses last about six weeks, sometimes longer. Inflammation markers in the blood are tracked to confirm the...
Antibiotics stop once the team is satisfied. You may continue physiotherapy to restore movement and strength, and...
What is bone and joint infection management?
Bone and joint infection management is the treatment of infections in a bone (osteomyelitis), inside a joint (septic arthritis), in the spine (discitis), or around an artificial joint (prosthetic joint infection). These infections are serious because they can damage bone and cartilage, spread, and affect how a limb or joint works in the long term.
Treatment is usually a combination of two things: surgery to drain pus, wash out a joint or remove infected or dead tissue, and a course of antibiotics. Wherever possible, a sample of fluid or bone is taken before antibiotics start, so the exact germ and the right antibiotic can be identified.
Antibiotic courses are long - commonly around six weeks, and sometimes longer for joint replacements or difficult infections. Treatment often begins in hospital and then continues at home or in a clinic, increasingly with tablets once the infection is under control, or with intravenous antibiotics through an outpatient service (OPAT) if drips are still needed.
The aim is to clear the infection, relieve pain, and protect the joint or bone for the future. It cannot always undo damage that has already happened, and some infections - particularly around metalwork or replacements - can be difficult to cure and may need more than one operation.
Types, options & approaches
There may be different ways to do this. The right approach depends on the clinical question and your circumstances.
Intravenous (drip) vs oral (tablet) antibiotics
| Feature | Intravenous | Oral (tablets) |
|---|---|---|
| When used | Severe or early phase | Often after control (per OVIVA) |
| Effectiveness | Long-standing standard | As good for many, per trial |
| Line needed | Yes (PICC/cannula) | No |
| Line complications | Possible (e.g. clots) | Avoided |
| Home delivery | Via OPAT service | Easier at home |
The OVIVA trial found that, for many bone and joint infections, switching to suitable oral antibiotics in the first six weeks worked as well as staying on a drip and avoided line problems. Your team decides what is right for your specific infection and germ.
Preparing for your treatment
- Expect samples of joint fluid, pus or bone to be taken before antibiotics where possible, so treatment can be targeted.
- Tell the team about all medicines, allergies (especially to antibiotics) and any metalwork or joint replacements you have.
- Mention diabetes, immune problems, kidney or liver disease, as these affect treatment choices and monitoring.
- Ask whether surgery is likely, and what type of anaesthetic would be used.
- Plan for a long treatment period: time off work, help at home, and possibly a tube (line) for drip antibiotics.
- Discuss how antibiotics will continue after hospital - tablets, or intravenous antibiotics through an outpatient service.
What happens
After assessment with blood tests and scans (such as X-rays, MRI or bone scans), the team usually takes a sample of fluid or bone to identify the germ. For an infected joint, this often means an urgent washout in theatre; for bone infection, surgery may remove dead or infected tissue.
Antibiotics are then started, at first often through a drip. Once the infection is under control and the germ is known, many people switch to tablets, or continue intravenous antibiotics at home through an OPAT service if drips are still needed. The total course commonly lasts around six weeks, and longer for some infections, especially around replacements.
Throughout treatment you have regular blood tests to track the infection and check the antibiotics are not causing problems, plus reviews to make sure you are improving. If there is metalwork or a replacement, the surgical and infection teams plan together whether it can stay or needs further surgery.
Is this treatment right for me?
A good consultation should explore whether it's the right choice for you now — including reasons to wait or consider something else.
May not be suitable if…
- Antibiotics alone are not enough when there is pus, a collection or dead bone that needs surgical drainage or removal.
- Oral-only treatment may be unsuitable if the germ is resistant, cannot be identified, or you cannot absorb or tolerate tablets.
- Trying to manage a severe or rapidly spreading infection outside a specialist team risks delay and harm.
- Implant-retaining strategies may not be appropriate for some infected joint replacements, where removal is safer.
Delay or rearrange if…
- Samples for the germ have not yet been taken and antibiotics could be safely held briefly to allow this (urgent sepsis aside).
- You are unstable with possible sepsis and need resuscitation and urgent surgery first.
- Kidney, liver or blood problems need correcting before certain antibiotics are used.
- Safe arrangements for home intravenous antibiotics or monitoring are not yet in place.
Alternatives to discuss
- Targeted oral antibiotics instead of prolonged drips, where the OVIVA evidence and your germ allow.
- Outpatient intravenous antibiotics (OPAT) instead of a long hospital stay.
- Different surgical strategies for infected replacements (washout and retain, versus remove and replace).
- Suppressive long-term antibiotics in selected people who are not fit for, or do not want, major surgery.
Before you decide
Use this as a shared-decision checklist. The aim is not just “can this be done?”, but whether it is right for you, now, with the risks and alternatives clearly understood.
What matters most to me?
Think about symptoms, daily life, work, caring responsibilities, sport, fertility, travel, appearance and anxiety — the right choice depends on your priorities, not just the medical facts.
What are all my options?
Ask about waiting, monitoring, medicines, rehabilitation, a smaller or larger procedure, a different test, NHS referral, or a second opinion where that would help.
What would make me pause?
Active infection, pregnancy, unstable medical problems, smoking, medicines that increase bleeding, poor support at home, or feeling pressured are all reasons to slow down and get tailored advice.
What happens if I do nothing today?
For some problems, waiting is safe; for others, delay can make treatment harder. A good consultation should explain the trade-off in plain English.
Comfort, sedation or contrast choices
If local anaesthetic, sedation, contrast or pain relief is used, ask what is planned, why, and what it means afterwards.
Benefits
- Clears or controls the infection and reduces the chance of it spreading
- Relieves pain, swelling and fever
- Protects the joint, bone or replacement and helps preserve function
- Targets the exact germ when samples are taken before antibiotics
- Allows much of the treatment to continue at home once you are stable
Risks & complications
- Antibiotic side effects such as nausea, diarrhoea, rash or thrush
- Tiredness and a slow recovery over weeks
- Stiffness or reduced movement in the affected joint or limb
- The inconvenience of long treatment, blood tests and follow-up
- Infection not fully clearing, or coming back, needing more antibiotics or surgery
- Complications from a drip line, such as a blocked line, clot or line infection
- Antibiotic-associated gut infection (such as Clostridioides difficile)
- Effects on the kidneys, liver or blood counts from prolonged antibiotics, picked up on monitoring
- Serious allergic reactions to antibiotics
- Lasting joint damage, deformity or the need for joint fusion or replacement
- Spread of infection to the bloodstream (sepsis), which can be life-threatening
- For infected replacements, the need to remove the implant
The most important issues are clearing the infection fully and protecting long-term function. Stopping antibiotics early, or not taking samples before they start, makes treatment harder. Infections around metalwork and joint replacements are particularly difficult and may need several operations - ask your team to be honest about the chance of cure and about line and antibiotic risks.
Published figures to discuss
Outcomes vary widely with the type and site of infection, the germ, the person's health, and whether there is metalwork or a joint replacement. Cure is generally more likely for straightforward bone or joint infection treated promptly, and harder for prosthetic joint infection. The OVIVA trial found oral antibiotics were non-inferior to intravenous antibiotics for the first six weeks, with fewer line complications. We have not attached precise success or recurrence percentages to your case because they depend heavily on these individual factors.
| Figure | Reported range | How to interpret it | Source / confidence |
|---|---|---|---|
| Treatment failure: oral vs intravenous antibiotics (first 6 weeks) | No significant difference between groups in the OVIVA trial | Oral antibiotics were non-inferior to intravenous for many bone and joint infections once treatment was guided by specialists; your team chooses based on the germ. | OVIVA non-inferiority RCT - scientific summary (NIHR / NCBI Bookshelf)ncbi.nlm.nih.govSource-linked context |
| Drip-line (intravenous catheter) complications | Around 1 in 10 intravenous patients in OVIVA had a line-related complication | Includes blockage, clot or line infection; this is one reason a switch to tablets is considered where suitable. | OVIVA non-inferiority RCT - scientific summary (NIHR / NCBI Bookshelf)ncbi.nlm.nih.govPublished figure |
| Relapse or persistent infection | Higher with prosthetic joints, metalwork, poor source control or resistant organisms | Antibiotics alone may not cure infection if infected tissue, abscess or loose metalwork is not dealt with. | OVIVA non-inferiority RCT - scientific summary (NIHR / NCBI Bookshelf)ncbi.nlm.nih.govSource-linked context |
| Antibiotic toxicity or interaction | Drug- and duration-dependent | Long courses need monitoring for liver, kidney, blood-count, tendon, nerve or gut side effects depending on the antibiotic. | OVIVA non-inferiority RCT - scientific summary (NIHR / NCBI Bookshelf)ncbi.nlm.nih.govSource-linked context |
These are literature figures, not a personalised prediction. Your own risks and likely benefits depend on your circumstances, your health, and how your care is carried out and followed up.
What happens afterwards
Recovery from a bone or joint infection is gradual. Symptoms usually improve over weeks, but bone and joints heal slowly, and you may need rehabilitation to regain movement and strength.
- A gradual, week-by-week reduction in pain, swelling and fever
- Tiredness while your body fights the infection and recovers
- Mild antibiotic side effects such as nausea or loose stools
- Stiffness that improves with physiotherapy and time
- Needing regular blood tests and reviews throughout the course
Aftercare
- Take every dose of antibiotics for the full course, even after you feel completely well.
- Attend all blood tests, which check both the infection and the safety of the antibiotics.
- If you have a drip line, keep it clean and dry, and follow the team's instructions for looking after it.
- Report side effects such as severe diarrhoea, rash, or feeling generally unwell, rather than stopping antibiotics yourself.
- Follow advice on weight-bearing, movement and physiotherapy to protect the joint or bone.
- Look after any surgical wound and watch for signs of wound infection.
- Keep follow-up appointments, including scans or X-rays, so healing and any late problems are checked.
- Know who to contact urgently if the area becomes more painful, red or swollen, or if you develop a fever.
- A clear, written antibiotic schedule and end date
- Dates for blood-test monitoring
- Line-care instructions and supplies if on a drip
- Wound-care advice if you have had surgery
- A physiotherapy or mobility plan
- Help arranged at home for the early weeks
- Emergency contact details for your infection or surgical team
Scars and how they heal
If surgery is needed - for example to wash out a joint or remove infected bone - you will have a wound and scar whose size depends on the operation. If a drip line such as a PICC is used, there will be a small entry site on the arm that should stay clean and dry and heals after the line is removed.
⚠ Get urgent help if…
- A spreading high fever, shivering, a fast heartbeat or feeling very unwell - possible signs of sepsis (call 999 or seek emergency care).
- Rapidly increasing pain, redness, heat or swelling around the bone, joint or wound.
- Pus or fluid leaking from a wound, or a wound opening up.
- Severe or worsening diarrhoea while on antibiotics.
- A drip line that becomes red, painful, swollen, leaks, or stops working.
- Sudden new weakness, numbness or loss of bladder or bowel control (especially with a spinal infection).
- A severe allergic reaction to antibiotics - rash, facial or lip swelling, or breathing difficulty.
Who to contact: your clinician, clinic or test provider first (keep their number to hand). For urgent advice when you can't reach them, call NHS 111. In an emergency, call 999.
General guidance — it doesn't replace the specific advice your specialist gives you.
Results & realistic expectations
A good outcome means the infection clears, pain and fever settle, blood markers of inflammation return towards normal, and the joint or bone keeps as much function as possible. For many people this is achieved with surgery plus a course of antibiotics, and recent evidence shows tablets can be as effective as drips once the infection is controlled.
Treatment cannot always reverse damage that has already happened, and it cannot guarantee that an infection will not return, especially around metalwork or a joint replacement. Success is judged over weeks to months, with ongoing review, rather than at a single point.
Most bone and joint infections that are treated promptly and fully do not return. The risk of recurrence is higher when there is metalwork, a joint replacement, poor blood supply, diabetes, or dead bone that has not been removed. Bone takes months to remodel and heal, and follow-up is often continued for a year or more to detect late problems. Stopping antibiotics early, or incomplete surgery, increases the chance of the infection coming back.
Related tests, treatments or support
Bone and joint infection care is usually delivered by more than one team working together - for example orthopaedic surgeons, infection specialists, microbiologists, radiologists and physiotherapists, and vascular or diabetes teams for foot infections. Intravenous antibiotics are frequently continued through an outpatient parenteral antibiotic therapy (OPAT) service, and physiotherapy runs alongside to restore movement.
Follow-up & long-term care
You will have regular reviews and blood tests during the antibiotic course to confirm the infection is settling and the antibiotics are safe. After treatment, follow-up - often with X-rays or scans - checks that healing continues and watches for recurrence, particularly after surgery or with a replacement. Any return of pain, swelling, fever or wound problems should prompt earlier review.
- Complete the full antibiotic course and attend all monitoring blood tests.
- Continue physiotherapy and follow weight-bearing advice to protect the joint or bone.
- Keep follow-up scans and appointments, sometimes for a year or more after surgery.
- Manage underlying conditions such as diabetes that raise the risk of recurrence.
- Report any return of pain, swelling, fever or wound problems promptly.
Repeat, follow-on and what comes next
- Infections around joint replacements may need more than one operation, sometimes removing and later re-implanting the joint.
- Antibiotic choice or route may be changed once culture results return or if side effects occur.
- Recurrence can require a further, sometimes longer, course of treatment.
- Some people are managed with long-term suppressive antibiotics rather than repeated surgery.
Ask what happens if the result is unclear or needs repeating, and what is included if further tests or follow-up are needed.
What good aftercare looks like
- A named infection and surgical team with a clear emergency contact route.
- A written antibiotic plan, end date and schedule of monitoring blood tests.
- Proper line care and prompt response to line problems if on intravenous antibiotics.
- Structured follow-up, including imaging where needed, to confirm healing and catch recurrence early, with physiotherapy to restore function.
What affects the cost
Costs vary a great deal between people and providers, and we don't publish prices. What matters is understanding what drives the cost and making sure your quote is complete. The main things that affect it:
- Whether surgery is needed, and the type and number of operations
- Length of hospital stay and whether care continues at home
- The antibiotics used and how long the course lasts
- Whether intravenous antibiotics are given through an OPAT service, including line insertion and care
- Frequency of blood-test monitoring and follow-up scans or X-rays
- Input from several specialists (surgery, infection, microbiology, physiotherapy) and rehabilitation
- Surgeon and infection-specialist fees and the facility/theatre cost
- Anaesthetic costs if surgery is needed
- The cost of antibiotics and the full treatment course
- OPAT and line insertion, care and removal if intravenous antibiotics continue at home
- Blood-test monitoring and follow-up imaging
- What happens, and what it costs, if the infection persists or recurs or further surgery is needed
On the NHS? Bone and joint infections are managed on the NHS by specialist orthopaedic and infection teams; private care follows the same principles and often shares the same OPAT and surgical pathways.
You're entitled to your total cost in writing — including reports, follow-up and what happens if the result is inconclusive — before you decide.
Consent traps and marketing red flags
These are not small details. They are often where patients lose choice, time to reflect, or realistic expectations.
Consent traps
- Starting antibiotics before samples are taken when this could be safely avoided, making the germ harder to identify.
- Not discussing the option of switching from drips to tablets where the evidence supports it.
- Underplaying how hard infected joint replacements can be to cure and the chance of further surgery.
- No clear plan for line care, monitoring blood tests, or who to contact in an emergency.
Marketing red flags
- Promises of a quick or guaranteed cure for bone or prosthetic joint infection.
- Offering antibiotics without identifying the germ or involving an infection specialist.
- Downplaying the need for surgery when there is pus or dead bone.
- Unproven 'immune-boosting' or alternative treatments offered instead of standard care.
Choosing a specialist safely
- Check the specialist is on the GMC Specialist Register for this area.
- Make sure they work at a CQC-registered service, and look for membership of the relevant Royal College or professional body.
- You're entitled to time to consider and to have your questions answered before you agree — the specialist who looks after you should explain it, not a salesperson.
- Be wary of pressure: time-limited offers or deposits taken before you've had time to think are red flags, not bargains.
- You're entitled to your total cost in writing — including any follow-up — before you decide.
Questions to ask your medical professional
Take this to your consultation. A good specialist will welcome every one of these.
- What germ is causing my infection, and was a sample taken before antibiotics started?
- Will I need surgery, and could I switch from a drip to tablets, as in the OVIVA trial?
- How long is my course, and how will it be monitored?
- If I have metalwork or a replacement, what is the chance of cure and might I need more surgery?
- Who do I contact, and what are the warning signs, if I get worse during treatment?
- Are you on the GMC Specialist Register for this area, and which Royal College or professional body are you a member of?
- Will you be the specialist who carries out my treatment, and who looks after me afterwards?
- What are the risks for someone like me, and how often do your own patients have a problem or need it repeated or redone?
- What does a realistic result look like — and what can this treatment not achieve?
- What are my options, including waiting, doing nothing for now, or choosing a different approach?
- Can I have written information, results and aftercare instructions in a format I can use, including any accessibility or communication support I need?
- What is the total cost in writing, including any follow-ups, and how much time do I have to decide?
Frequently asked questions
Do I have to have antibiotics through a drip?
How long will I be on antibiotics?
Will I definitely need surgery?
Can an infection around my joint replacement be cured?
Can I have this treated privately?
What happens if I stop antibiotics early?
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How we made this page
Medically reviewed by a GMC-registered consultant. Written in plain English, checked against NHS, NICE, GMC and relevant Royal College / specialist-society guidance, and kept under review. No clinic paid to appear on this page, and we publish no pricing. This is general information to help you prepare — it is not a substitute for advice from your own clinician. How we review our guides →
Source hierarchy: UK regulator and NHS/NICE guidance first, then relevant Royal College or specialist-society guidance, then peer-reviewed evidence for procedure-specific figures where available.
Sources & standards: OVIVA trial - Oral versus Intravenous Antibiotics for Bone and Joint Infection (NEJM) OVIVA non-inferiority RCT - scientific summary (NIHR / NCBI Bookshelf) NHS England - Specialised commissioning: bone and joint infection BOAST - Management of children with acute musculoskeletal infection (British Orthopaedic Association) NHS Scotland Right Decisions - Bone and joint infections (antimicrobial)
Reviews reflect patients' experience of care, not clinical outcomes. For procedure volumes and outcome data see PHIN.
Last medically reviewed 2026-09-21. Spotted something wrong or out of date? Report an error in this guide.
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