Purpose To investigate the correlation between preoperative bilirubin level and periprosthetic joint infection (PJI) after hip and knee arthroplasty. Methods A retrospective analysis was performed on patients undergoing revision hip and knee arthroplasty at the orthopedics department of the 1st medical center, Chinese PLA General Hospital from January 2016 to December 2018. Blood routine examination, blood biochemical, blood coagulation, C-reactive protein, Interleukin-6, erythrocyte sedimentation rate, d-dimer and other laboratory indicators were collected before the initial replacement, as well as general patient information，The correlation between the above indicators and postoperative PJI was analyzed. Results A total of 39 patients (14 hips/ 25 knees) were included according to the admission criteria, including 22 patients in the PJI group and 17 patients in the non-PJI group. Except for total bilirubin and diameter bilirubin, there was no significant difference between the remaining preoperative test indexes of the two groups. The preoperative total bilirubin and direct bilirubin in the PJI group were 11.00±0.95 mol/l and 3.36±0.28 mol/l, respectively, which were lower than those in the non-PJI group (15.02±1.12 mol/l and 4.87±0.68 mol/l, P=0.0092 and 0.0305). The AUC of preoperative total bilirubin to predict PJI was 0.7286 (P=0.01549, Cutoff=13.05 mol/l, sensitivity=68.18%, specificity=70.59%). Meanwhile,the AUC of preoperative direct bilirubin to predict PJI was 0.6832 (P=0.0488, Cutoff=4.00 mol/l, sensitivity=77.27%, specificity =58.82%). Conclusions The serum levels of total bilirubin and direct bilirubin before the primary replacement of PJI patients were lower than those non-PJI patients, and the decreased preoperative values could be considered as risk factors for postoperative PJI.