Does Preoperative Air Travel Increase Infection Risk After Total Knee Arthroplasty? a Propensity-Matched Analysis Publisher Pubmed



Hoveidaei A H ; Pirahesh K ; Alnasser A A ; Suresh S J ; Adolf J ; Bingham J S ; Conway J D
Source: Journal of Arthroplasty Published:2026

Abstract

Background Infection after total knee arthroplasty (TKA), particularly periprosthetic joint infection (PJI), is a serious complication associated with high morbidity, revision, and health care burden. Although venous thromboembolism has been linked to perioperative air travel, little is known about infection risk. This study sought to clarify whether preoperative air travel is associated with (1) PJI at 90 days and two years, (2) superficial surgical site infection (SSI) at 30 and 90 days, and (3) septicemia at 30 and 90 days. Methods We conducted a retrospective cohort study using a database. Elective primary TKA patients were categorized as “likely air travel” or “likely land travel” based on residence relative to surgery location. After propensity score matching, 11,866 patients were included in each group. Outcomes were assessed with odds ratios and 95% confidence intervals. Results In this matched cohort of 23,732 patients, no significant differences were observed in infectious outcomes between groups. In the air travel and land travel cohorts, respectively, PJI occurred in 0.5 versus 0.5% at 90 days and 1.0 versus 1.0% at two years ( P > 0.60). The SSI rates were 1.3 versus 1.4% at 30 days and 1.8 versus 2.0% at 90 days ( P > 0.20). Septicemia was rare in both groups (0.1 to 0.2%, P > 0.60). Multivariable regressions and Charlson Comorbidity Index–stratified subgroup analyses similarly demonstrated no significant differences between the matched cohorts. Conclusions Preoperative air travel was not associated with increased risk of PJI, superficial SSI, or systemic infection after elective TKA. Further research is needed to evaluate whether similar outcomes apply to international travel, where pathogen exposure and infection control practices may differ. © 2026 Elsevier Inc.