We present the first reported case of a total hip arthroplasty infected with Lactobacillus casei as a result of enteric bacterial translocation. A 76-year-old woman was found to have an infected right total hip arthroplasty hip 4 and a half years after her primary procedure. The patient who was treated underwent a 2-stage revision total hip arthroplasty. This patient was a regular consumer of probiotic yoghurt drinks and had multiple risk factors for developing this rare infection. Because of the high mortality of infections caused by lactobacillus, if a patient develops a chronic lactobacillus prosthetic joint infection, we recommend aggressive 2-stage revision arthroplasty surgery with multidisciplinary management involving both orthopedic and infectious diseases specialists.