Post-Operative Infections: Reducing the Risk of Infection after Orthopaedic Surgery

Infections after surgery are uncommon, but they can happen. The good news is that many of the risk factors for infection can be identified and improved before surgery. Understanding these factors can help you and your healthcare team lower your risk and improve your recovery. Additionally, early identification and treatment of post-operative infections often allows for effective treatment.

Risk Factors for Developing a Post-Operative Infection

Not ever patient undergoing surgery has an equal chance of developing a post-operative infection. There are a variety of factors that affect the likelihood that a patient will develop an infection following surgery. These factors include:

• Patient Health Factors
• Skin Contamination
• Type of Surgery
• Surgical Precautions (During Surgery)
• Post-Operative Care (After Surgery)

Patient Health Factors

Certain medical conditions can increase the risk of infection:

• Diabetes – especially if blood sugar is not well controlled
• Obesity – extra weight can put stress on the wound and slow healing
• Poor nutrition – your body needs proper nutrition to heal
• Smoking or nicotine use – reduces blood flow and slows healing
• Weakened immune system – from medications or medical conditions

What you can do: Work with your doctor to control blood sugar, improve nutrition, and stop smoking before surgery.

Skin Contamination

Bacteria that live on the skin can sometimes cause infection after surgery.

• Skin problems like rashes, cuts, or ulcers near the surgical site increase risk
• Some people carry bacteria such as Staph (including MRSA) without symptoms

What you can do: Follow instructions for skin cleaning before surgery and let your doctor know if you have any skin problems.

Type of Surgery

Some surgeries carry a higher risk of infection than others.

• Long or complex procedures increase risk
• Revision (repeat) surgeries are higher risk
• Surgeries with implants (like joint replacements or plates/screws) have a higher risk because bacteria can stick to these surfaces

What you should know: Your surgeon takes extra precautions for higher-risk procedures.

Surgical Precautions (During Surgery)

There are several important steps your surgical team takes to reduce infection risk:

• Giving antibiotics before surgery
• Keeping the operating room sterile and controlled
• Minimizing surgery time and tissue damage

These steps are standard and carefully followed by your surgical team.

Post-Operative Care (After Surgery)

Your recovery period is very important for preventing infection.

• Keep your incision clean and dry. Dressings are often put on sterile in the operating room and left on until the wound has closed and started to heal.
• Watch for drainage, redness, or swelling
• Avoid putting too much stress on the surgical area too soon

Call your doctor if you notice:

• Increasing pain or swelling
• Redness or warmth around the incision
• Fever or chills
• Drainage from the wound

Treatment of Post-Operative Infections

Post-operative infections are treated based on how serious the infection is, where it is located, and whether implants or foreign material (ex. sutures) are involved.

In mild cases, the infection may only involve the skin around the incision. These infections are often treated with oral antibiotics and careful wound care. The surgical site is kept clean and dry, and any drainage is monitored. Sometimes a doctor may open a small part of the incision to allow fluid or pus to drain, which helps the body clear the infection. This is done because a collection of infected tissue (an abscess) will not resolve unless the pus is released because there is no local blood supply to the abscess meaning that antibiotics and the body’s immune system cannot reach all of the infected area.

If the infection is deeper, more extensive, or involves foreign material (such as an implant), stronger treatment is needed. This may include intravenous (IV) antibiotics, which are given through a vein, often in the hospital. In many cases, especially in orthopaedic surgery, a second surgical procedure is required. During this procedure, the surgeon cleans out the infected area (called a “washout” or debridement) and removes any dead or infected tissue. If hardware such as plates, screws, or joint replacements are present, the surgeon may try to keep them in place if the infection is caught early. However, in more severe or long-standing infections, the hardware may need to be removed or replaced.

Recovery from a post-operative infection can take time. Patients often need several weeks of antibiotics, along with close follow-up to make sure the infection is improving. Physical therapy may be delayed or modified while the infection is treated. Most infections can be successfully treated, especially when they are recognized early. It is important for patients to watch for signs of infection—such as increased pain, redness, swelling, fever, or drainage from the wound—and to contact their doctor right away if these symptoms occur.

Summary

Post-operative infections are uncommon, but they can happen, and understanding the risk factors can help reduce the chance of developing one. Your risk of infection after surgery depends on several things, including your overall health (such as diabetes, smoking, and nutrition), the condition of your skin, the type of surgery performed, and how closely you follow your post-operative care instructions. The good news is that most infections can be prevented by optimizing your health before surgery, carefully following wound care and activity instructions, and contacting your healthcare team early if something does not seem right, such as increased pain, redness, swelling, or drainage. By working closely with your healthcare team and taking an active role in your recovery, you give yourself the best chance for a safe healing process and a successful outcome.

Edited by Stephen Pinney MD, April 26th, 2026.