Seasonal Relationship of Prosthetic Joint Infection Following Primary Total Joint Arthroplasty in a Subtropical Climate: A Retrospective Cohort Study

Background: One devastating complication that leads to increased morbidity and mortality rates after total joint arthroplasty (TJA) is prosthetic joint infection (PJI). Evidence on the relationship between climate, seasonality, and the risk of developing a PJI conflicts. The objective of this study was to investigate the effect of seasonality and climate change on the rate of PJI. Methods: We retrospectively reviewed data of patients undergoing primary TJA at a single institution in a subtropical climate location from 2012 to 2015. Only primary TJAs with a minimum of 1-year follow-up were included in the analysis. Patient demographics and complications were extracted from the database, and monthly average temperature, humidity, and precipitation were obtained. The primary endpoint was PJI requiring revision surgery within 1 year of the index procedure. Results: A total of 3,696 TJAs met the inclusion criteria, with 28 PJIs requiring a second surgery within 1 year (0.76%). We found no significant difference in age, sex, or body mass index in patients who developed a PJI (P=0.9450, P=0.0989, and P=0.7942, respectively). The highest incidence of PJI occurred in August (1.49%), but the incidence of PJI by month was not significant (P=0.8996). July and August were the hottest (91 °F) and most humid (79%) months, and June had the most average precipitation (8.06 inches); however, these climate variables were not significant contributors to the incidence of PJI (P=0.4996, P=0.4999, and P=0.4957, respectively). Conclusion: We found no association between temperature, humidity, and development of PJI in a North American subtropical climate. Surgeons can use this information to counsel patients when planning for TJA.