Deep periprosthetic joint infection (PJI) is one of the most feared complications of hip and knee replacement surgery as it generally requires a combination of surgical intervention(s) and prolonged antibiotic therapy. Patients with previous joint replacement have a lifetime risk of secondary PJI after other common infections. The lifetime risk has been reported to be up to 2% at 20 years after total hip arthroplasty taking into account infection from a subsequent revision procedure as well. Streptoccoccus spp. are commonly implicated in these infections. Early recognition and prompt treatment of soft tissue, dental and respiratory infections may also prevent secondary PJI. Acute haematogenous PJI should be suspected if a patient with a joint replacement develops pain in that joint after infection elsewhere. If PJI does occur in this context, optimal outcomes are achieved by early diagnosis, referral and treatment.