JOA - 2026-06-03 - Journal Article
Does Preoperative Air Travel Increase Infection Risk After Total Knee Arthroplasty? A Propensity-Matched Analysis.
Hoveidaei AH, Pirahesh K, Alnasser AA, Suresh SJ, Adolf J, Bingham JS, Conway JD
Topics
Key Takeaway
Preoperative air travel was not associated with increased PJI risk after primary TKA, with identical 90-day PJI rates of 0.5% in both air and land travel cohorts across 23,732 propensity-matched patients.
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Summary
This study asked whether preoperative air travel increases infectious complications after elective primary TKA. Using a large administrative database, patients were classified as air vs. land travelers by residence-to-surgery distance and propensity-matched on comorbidities; outcomes included PJI, SSI, and septicemia at 30, 90 days, and 2 years. No significant differences were found across any infectious endpoint, with PJI at 2 years of 1.0% in both groups and septicemia rates of 0.1–0.2% in both cohorts.
Key Limitation
Travel classification relies entirely on geographic inference from administrative data rather than confirmed travel records, meaning misclassification of both groups is probable and could dilute any true effect.
Original Abstract
BACKGROUND
Infection after total knee arthroplasty (TKA), particularly periprosthetic joint infection (PJI), is a serious complication associated with high morbidity, revision, and healthcare 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 (ORs) and 95% confidence intervals (CIs).
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 (CCI)-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.