A recent study conducted by investigators at the Hospital for Special Surgery (HSS) found that infection rates following total knee arthroplasty (TKA) are consistently low at a high-volume academic orthopedic center, regardless of how many procedures individual surgeons perform each year. The findings were presented at the American Academy of Orthopedic Surgeons (AAOS) 2026 Annual Meeting.
Total knee replacement is one of the most frequently performed elective surgeries in the United States, with more than 700,000 cases annually. Despite improvements in surgical techniques and antibiotic use, infections after TKA remain a serious complication and have prompted increased attention to factors that can be controlled.
“Historically, it’s been said that the higher a surgeon’s volume, the lower the rate of infection, and the corollary is that low-volume surgeons are considered to have a higher risk of infection,” said Geoffrey H. Westrich, MD, hip and knee surgeon at HSS and senior author of the study. “We wanted to take a closer look at this historic paradigm to determine if surgeon volume independently affects infection outcomes at a high-volume orthopedic center that places great importance on infection prevention.”
“At HSS, we perform thousands of joint replacements each year and we have an incredibly robust infection prevention program that has resulted in infection rates that are among the lowest in the nation,” Dr. Westrich continued. “However, the biggest problem with infection research is that because our rates are so low, it’s hard to isolate the impact of individual surgeon volume from the many institutional factors that influence outcomes.”
The researchers reviewed data collected prospectively for all TKA procedures performed at HSS between January 1, 2018, and December 30, 2024—a total of 33,747 surgeries by 52 surgeons. Surgeons were categorized based on annual case volume: low (250 cases/year). Infection outcomes such as superficial surgical site infections (SSI) and deep periprosthetic joint infections (PJI) were tracked for 90 days post-surgery using protocols aligned with National Healthcare Safety Network criteria.
Results showed average operative times were longer for lower-volume surgeons but there was no statistically significant difference in SSI or PJI rates across groups: PJI ranged from 0.2% to 0.3%, while SSI ranged from 0.1% to 0.2%.
Dr. Westrich noted these results compare favorably with other hospitals statewide: “Our HSS infection rates, which range from 0.1% to 0.3%, are among the lowest in New York State and in our country,” he said. “At other New York State hospitals, infection rates can be as high as 2.0% or ten times higher than our institution.”
“Our findings demonstrate that at a high-volume academic orthopedic center, infection rates following total knee replacement remain uniformly low regardless of individual surgeon volume,” Dr. Westrich added.“This flies in the face of what we’ve been told historically about surgeon volume and infection rates.It’s not just the surgeon,it’s the institution that drives safety.”
He explained further: “At HSS, controlling the risk of infection is among our highest priorities and most important accomplishments.Our low infection rates are achieved with a robust infection-control committee, extensive patient education,state-of-the-art operating rooms,infection-reducing surgical practices,en-hanced sterilization methods,and highly disciplined infection-control practices.Together these factors outweighthevolumeoftheindividualsurgeon.”
To improve patient safety at orthopedic centers nationwide,D r.Westrich emphasized strengthening institutional infrastructure over restricting access for lower-volume surgeons.“Our study shows thatevenifyoubringasurgeononstaffwhoisjuststartingoutin their careerthatdoesn’tmeanapatientgoingtothatsurgeonisatgreaterriskofinfection.Arigorouscomprehensiveapproach topatientcarewithrelentlessfocusoninfectioncontrolateverystageprovidesthegreatestprotectionfrominfection.”
The authors listed on this study include Josef Jolissaint MD; Andrew Thomson BA; Alexandra Grizas MPH; Andy Miller MD;and Geoffrey H.Westrich MD.
HSS is recognized for its specialized orthopedic care,research contributions,and consistent top rankings nationally.It focuses on improving mobility,promoting quality patient care,and advancing research in orthopedics and rheumatology.More information about its programs can be found on its official website.
