Seasonality of infection rates after total joint arthroplasty

The correlation between season (fall, winter, spring, and summer) and infection rate in surgical patients is well defined in many specialties. To the authors' knowledge, there are no data in the literature on this phenomenon in patients undergoing total joint arthroplasty. They hypothesized that there would be an increased infection rate in the summer months in patients undergoing elective total joint arthroplasty. They retrospectively reviewed consecutive patients undergoing elective total hip or knee arthroplasty at a single institution during 1 year by a single surgeon. Wound infections were defined as any patient requiring oral antibiotics for cellulitis, readmission for intravenous antibiotics, a return to the operating room for irrigation and debridement, or excisional arthroplasty and placement of a cement spacer within 90 days of the initial procedure. Seventeen of 750 patients developed an infection, for an overall incidence of 2.2%. There was a statistically significant difference in infection rate according to season: 3 (1.5%) infections occurred in winter, 1 (0.5%) in spring, 9 (4.7%) in summer, and 4 (2.4%) in fall. The incidence was highest during July (4.5%), August (5.4%), and September (4.3%). There was a statistically significant difference in infection rate between summer/fall (3.6%) vs winter/spring (1.0%). There is an increase in the incidence of infection during summer months for patients undergoing total joint arthroplasty. The authors recommend increased surveillance and more thorough preoperative sterilization procedures during these warmer months.