SUMMARYIt can be difficult to differentiate septic from aseptic loosening of prosthesis and especially those due to delayed and late prosthetic-joint infection. In delayed and late prosthetic-joint infection, the acute signs and symptoms of infection such as fever, swelling, erythema and warmth are usually absent and the only manifestation may be implant loosening, persistent joint pain or both; same as aseptic loosening. The patient presented is a 62-year-old farmer who presented with implant loosening and with subtle clinical features that could not help differentiate septic from aseptic loosening. The diagnostic challenges faced and investigations that proved useful to differentiate septic from aseptic loosening are presented.
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