Is ‘Season’ a Risk Factor for Prosthetic Joint Infections?

BACKGROUND: There are no clear data whether the season of arthroplasty has any demonstrable effect on the emergence of PJI. In the present study we aimed to explore the effect of the season of arthroplasty surgery on the PJI incidence, and to test if season of arthroplasty is a risk factor for PJI. MATERIAL & METHOD: Our study involved 174 (2.5%) patients with superficial and/or deep infection among 6902 patients who underwent arthroplasty procedure at Taksim First Aid Training and Research Hospital, Baltalimanı Bone Hospital and Medipol University Hospital during an approximately 10-year period between January 2006 and June 2015. RESULTS: An analysis of the timing of the surgeries revealed that the first operations were most commonly performed in February (14.4%) and March (13.8%). The season in which most operations were performed was Spring (n=60; 34.5%) whereas Fall had the least number of operations (n=31; 17.8%) There were also no significant monthly or seasonal differences between the number of infections when separate analyses were done for hip joint (n=88) and knee joint replacements (n=86) (p>0.05) DISCUSSION: Despite the lack of a definitive information about the seasonal predilection of prosthetic joint infections, Kane et al showed a significantly increased incidence of infection in summer months among 750 patients operated with arthroplasty, of whom 17 suffered such infection (15). In contrast, among 174 prosthetic joint infections, we found no significant monthly and/or seasonal difference in the incidence of prosthetic joint infections.Increased moisture and temperature increase bacterial colonization both in the outer environment and on the host’s skin, increasing the sensitivity to infections. Perspiration of the host, closed environmental conditions, and increased moisture are other important factors promoting bacterial colonization (16,17). However, appropriate care of the surgical field following surgery is the most important factor reducing bacterial colonization of skin. Another significant problem with arthroplasty surgery is patient satisfaction, which is promoted by as short as possible waiting times from the time of decision to operate to the time of procedure.In conclusion, the incidence of prosthetic joint infections is not increased after arthroplasty operation in summer when bacterial colonization is promoted by increased temperature and moisture. Therefore, season does not appear as a risk factor.