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Health condition · Clinically reviewed

Bone and joint infections, from septic arthritis to prosthesis infection and spondylodiscitis.

Serious, often surgical, and time-critical. Modern UK care combines targeted antibiotics, imaging, and specialist bone infection teams to protect joints, limbs and the spine.

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A radiographer guides a patient onto the bed of an advanced 3 Tesla MRI scanner in a London imaging suite

Why trust this guide

  • 01

    Clinically reviewed

    Written by our editorial team and reviewed by a registered UK clinician before publication.

  • 02

    Sourced from guidance

    Checked against BSAC, IDSA, BOA and BSAB bone and joint infection standards you can see at the end.

  • 03

    Current for 2026

    Reflects modern UK bone infection practice including the OVIVA oral-switch trial and specialist orthopaedic centre pathways.

Key facts

Bone and joint infections at a glance.

The essentials, in plain English - the family of infections, the common bugs, and how the UK treats them.

  • What it is

    A family of deep infections affecting bone (osteomyelitis), joints (septic arthritis), prosthetic joints (PJI) and the spine (spondylodiscitis and discitis).

  • Common organisms

    Staphylococcus aureus in most cases, with Kingella in children, Salmonella in sickle cell, gonococcus in young sexually active adults and coagulase-negative staph and Cutibacterium in prostheses.

  • Emergency

    Septic arthritis destroys cartilage within hours - a hot, swollen, painful joint with fever needs same-day assessment and aspiration.

  • Gold-standard test

    MRI for bone and spinal infection; joint aspiration for septic arthritis; bone biopsy and culture for chronic osteomyelitis and PJI.

  • Antibiotics

    Long courses (4 to 12 weeks) guided by culture - the OVIVA trial supports oral switch after around 7 days IV in selected patients.

  • Surgery

    Washout, debridement, sequestrectomy or one- and two-stage revision arthroplasty are core to cure in most established infections.

Why this guide matters

Time-critical, specialist, and often curable.

Deep infection of bone or joint carries a real risk of permanent damage. The three points below shape everything else on this page.

  • Speed protects the joint

    Septic arthritis and epidural abscess are hour-critical - fast aspiration, imaging and antibiotics prevent lifelong damage.

  • Get the bug, get it right

    Cultures before antibiotics, and bone biopsy where possible - blind treatment leads to relapse and resistance.

  • Specialist centres change outcomes

    PJI, spondylodiscitis and chronic osteomyelitis are best managed in dedicated bone infection MDTs.

How the diagnosis is made

From first symptom to a targeted plan.

The steps a UK ED, orthopaedic team or infectious diseases service will normally follow - so you know what to expect and why.

  1. 01

    Assessing

    History and examination

    A structured look at symptom onset, risk factors (diabetes, IV drug use, prosthesis, recent surgery, sickle cell), joint findings and neurology.

  2. 02

    Assessing

    Inflammatory markers and cultures

    FBC, CRP, ESR and at least three sets of blood cultures drawn before antibiotics wherever possible.

  3. 03

    Assessing

    Urgent joint aspiration

    For a hot swollen joint - synovial fluid for microscopy, Gram stain, culture, WCC and crystals. A count above 50,000 with over 90 percent neutrophils strongly suggests septic arthritis.

  4. 04

    Confirming

    Imaging - MRI first for bone

    MRI is the gold standard for early bone and spinal infection, soft tissue involvement, collections and epidural abscess. X-ray changes lag by 10 to 14 days.

  5. 05

    Confirming

    CT and nuclear medicine

    CT defines sequestrum and bony detail. Three-phase bone scan, WBC scan or FDG-PET are used selectively when MRI is contraindicated or inconclusive.

  6. 06

    Confirming

    Bone biopsy and molecular tests

    Bone biopsy with culture is the gold standard for chronic osteomyelitis and PJI. 16S rRNA PCR and targeted PCR (TB, Kingella, Brucella, Bartonella) help culture-negative cases.

  7. 07

    Sourcing

    Source and TB workup

    Echo to exclude endocarditis when bacteraemia is present. IGRA, tissue AFB and mycobacterial culture where TB spondylitis (Pott disease) is suspected.

Typical timeline: from ED presentation to targeted therapy in hours to days.

Symptoms

What bone and joint infection looks like.

Some presentations are dramatic; others are quiet and chronic. The features that mean you need same-day assessment are clear.

  • Hot, swollen, painful joint

    Septic arthritis - fever, reduced range of movement and refusal to weight-bear in children. A same-day emergency.

  • Focal bone pain and fever

    Osteomyelitis - deep aching bone pain, point tenderness and systemic upset, often with a limp or reluctance to use the limb.

  • Sinus tract and drainage

    Chronic osteomyelitis or PJI - a discharging sinus overlying bone or an implant is diagnostic until proven otherwise.

  • Back pain with fever

    Spondylodiscitis - unremitting back pain, night pain and fever. Any new neurology is a red flag for epidural abscess or cord compression.

  • Prosthetic joint pain

    PJI - persistent pain after arthroplasty, effusion, wound drainage, sinus or early implant loosening on X-ray.

  • Diabetic foot ulcer probing to bone

    A positive probe-to-bone test in a diabetic foot ulcer is a strong signal for underlying osteomyelitis.

  • Sickle cell bone pain

    Salmonella osteomyelitis is over-represented in sickle cell disease - distinguishing infection from a vaso-occlusive crisis needs care.

  • Red flag - cord compression

    Back pain with fever plus new weakness, sensory change, saddle anaesthesia or bladder or bowel disturbance is a neurosurgical emergency.

Treatment

How bone and joint infections are treated in the UK.

Source control, culture-guided antibiotics and specialist rehabilitation - often with revision surgery for prostheses and the spine.

  • Urgent joint washout

    Septic arthritis - arthroscopic or open washout with serial procedures until sterile, alongside IV empirical antibiotics.

  • Empirical IV antibiotics

    Flucloxacillin plus ceftriaxone, with vancomycin added when MRSA is suspected - narrowed once cultures return.

  • Targeted long-course antibiotics

    4 to 6 weeks for native bone and joint infection, longer for PJI and spondylodiscitis - guided by culture and specialist microbiology.

  • Surgical debridement

    Sequestrectomy, dead-space management and stabilisation for chronic osteomyelitis and complex fractures.

  • DAIR for early PJI

    Debridement, antibiotics and implant retention for well-fixed early prosthetic joint infection, followed by prolonged suppressive antibiotics.

  • One- or two-stage revision

    Revision arthroplasty with an antibiotic-loaded spacer for established PJI - delivered in specialist bone infection centres.

  • Rifampicin combination

    A cornerstone anti-biofilm agent for staphylococcal bone and prosthesis infection, always paired to prevent resistance.

  • MDT bone infection care

    Orthopaedics, infectious diseases, microbiology, plastics, endocrinology and rehabilitation working together at a specialist centre.

What this guide is based on

The sources behind every claim on this page.

UK and international bone and joint infection standards, current at the time of last review.

Key references

Guidelines and standards we relied on.

A quiet reminder

This guide is for information, not medical advice.

Your orthopaedic surgeon, infectious diseases team or GP knows your history and imaging and can tell you which parts apply to you. If in doubt, get seen.

  • BSAC. Good practice recommendations for outpatient parenteral antimicrobial therapy (OPAT) and bone and joint infection.

  • IDSA. Clinical practice guidelines on native vertebral osteomyelitis, diabetic foot infection and prosthetic joint infection.

  • BOA and British Society for Antimicrobial Chemotherapy (BSAB) joint standards for bone and joint infection.

  • Li HK et al. Oral versus intravenous antibiotics for bone and joint infection (OVIVA). NEJM 2019.

  • NICE. Diabetic foot problems: prevention and management (NG19).

Red flags

When bone and joint infection needs urgent attention.

These situations need same-day assessment - almost always in hospital, and often surgical.

  • Suspected septic arthritis

    A hot, swollen, painful joint with fever is an emergency - same-day aspiration and IV antibiotics can prevent cartilage destruction.

  • Spinal epidural abscess

    Back pain and fever with new neurology - urgent MRI and neurosurgical review to prevent permanent cord damage.

  • Cauda equina features

    Saddle anaesthesia, bladder or bowel disturbance or bilateral leg weakness - emergency imaging and referral.

  • Sepsis

    New confusion, high fever, tachycardia, low blood pressure or reduced urine output - resuscitate and treat under sepsis pathways.

  • Discharging sinus over an implant

    Almost always represents PJI - refer to a specialist bone infection centre rather than treating with community antibiotics.

  • Failing diabetic foot

    Non-healing ulcer, probe-to-bone, spreading cellulitis or ischaemia - urgent diabetes foot MDT with vascular input.

  • IV drug use with back pain

    Consider spondylodiscitis and endocarditis - low threshold for MRI, blood cultures and echo.

  • Sickle cell with focal bone pain

    Distinguish Salmonella osteomyelitis from a vaso-occlusive crisis - blood cultures, MRI and haematology input.

  • Open fracture

    Grade under Gustilo-Anderson, IV antibiotics within one hour, tetanus cover and combined orthoplastic care.

Living with it

A serious diagnosis, with a clear path back.

Four things that make the biggest difference over the months of treatment - sticking with antibiotics, optimising your health, rehabilitating properly and staying in specialist follow-up.

A quiet reminder

Cure is often measured in months, not weeks.

Recovery from deep bone infection is slow and staged. Consistency, and a low threshold for calling the team, protect the long-term result.

  1. 01 Adherence

    Finish the course

    Bone and joint infections need long antibiotic courses (weeks to months). Skipped doses and early stops are the commonest reason for relapse.

  2. 02 Health

    Optimise the terrain

    Good glycaemic control, stopping smoking, nutrition, vascular assessment and dental review all reduce the risk of relapse and implant failure.

  3. 03 Rehab

    Move well again

    Physiotherapy and staged weight-bearing rebuild strength and function - especially after revision arthroplasty or spinal stabilisation.

  4. 04 Follow-up

    Stay under specialist review

    Bone infection teams monitor markers, imaging and function for months to years - relapse can be late and quiet.

Frequently asked

Everything we get asked about bone and joint infection.

Quick answers on septic arthritis, osteomyelitis, prosthetic joint infection and spinal infection.

  • What is a bone or joint infection?

    It is a deep infection of bone (osteomyelitis), a joint (septic arthritis), a prosthetic joint (PJI) or the spine (spondylodiscitis and discitis). Most are bacterial - Staphylococcus aureus is the commonest organism in the UK - and most need a combination of long antibiotic courses and surgery to cure.

  • Why is septic arthritis an emergency?

    Bacteria in a joint destroy cartilage within hours. A hot, swollen, painful joint with fever needs same-day joint aspiration, IV antibiotics and surgical washout to save the joint. Delay leads to permanent joint damage.

  • How is osteomyelitis diagnosed?

    Blood tests (CRP, ESR, cultures) start the workup. MRI is the gold-standard imaging test for early bone infection because X-ray changes lag by up to two weeks. In chronic disease and PJI, bone biopsy with culture is the definitive test.

  • What is prosthetic joint infection and how is it treated?

    PJI is infection around a hip, knee or other joint replacement. Early infection (within 3 months) can sometimes be treated with debridement, antibiotics and keeping the implant (DAIR). Later infection usually needs one- or two-stage revision arthroplasty in a specialist bone infection centre, with prolonged targeted antibiotics.

  • Do I need IV antibiotics for weeks?

    Not always. The OVIVA trial (NEJM 2019) showed that in selected patients with bone and joint infection, switching to oral antibiotics after about a week of IV therapy was not inferior to continuing IV. Your specialist team will decide based on organism, source control and your response.

  • Where in the UK are these infections treated?

    Complex bone and joint infection is delivered in specialist centres - such as the Royal National Orthopaedic Hospital Stanmore, Nuffield Orthopaedic Centre Oxford, Robert Jones and Agnes Hunt Oswestry, Wrightington, Cambridge, Newcastle and Sheffield - by a multidisciplinary team of orthopaedics, infectious diseases, microbiology and plastics.

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