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Infection rates at a high-volume academic orthopaedic center following total knee arthroplasty (TKA) are uniformly low regardless of individual surgeon volume, according to a recent study from the Hospital for Special Surgery (HSS).

This finding, shared at the Annual Meeting of the American Academy of Orthopaedic Surgeons, challenges the long-held belief that a surgeon’s experience – not the experience and commitment of the institution – drives safety outcomes.

“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 senior author Geoffrey H. Westrich, MD, an adult reconstruction surgeon at HSS.

“We wanted to take a closer look at this historic paradigm to determine if surgeon volume independently affects infection outcomes at a high-volume orthopaedic center that places great importance on infection prevention.”

Study Findings

The researchers conducted a retrospective review of prospectively collected data at HSS that included all TKA procedures (33,747) performed between January 1, 2018, and December 30, 2024. A total of 52 surgeons were stratified by annual TKA case volume into 3 categories:

• Low volume (<50 cases/year)
• High (50–250 cases/year)
• Ultra-high (>250 cases/year)

Infection outcomes, including superficial surgical site infections (SSI) and deep periprosthetic joint infections (PJI), were monitored for 90 days postoperatively using a dedicated surveillance program in accordance with National Healthcare Safety Network (NHSN) criteria.

The researchers found that:

• The low-volume group had an average operative time of 112.2 minutes, a PJI rate of 0.3%, and an SSI rate of 0.2%.
• The high-volume group had an average operative time of 96.5 minutes, a PJI rate of 0.3%, and an SSI rate of 0.1%.
• The ultra-high-volume group had an average operative time of 90.5 minutes, a PJI rate of 0.2%, and SSI rate of 0.1%.

Despite differences in operative time, there were no statistically significant differences in infection rates across the three surgeon volume groups with respect to both SSI and PJI.

Infection Prevention at HSS

As a result of a robust infection prevention program, TKA infection rates across the surgeon volume groups are extremely low compared with other hospitals in New York state, according to Dr. Westrich.

“Our HSS infection rates, which range from 0.1% to 0.3%, are among the lowest in New York state and the country,” he said. “At other New York state hospitals, infection rates can be as high as 2.0%, or 10 times higher than at our institution.”

To improve patient safety and quality care at orthopaedic centers, Dr. Westrich emphasizes the importance of strengthening institutional infrastructure and quality-improvement programs, rather than limiting low-volume surgeons’ access to TKA. He said that at HSS, this includes:

• Strong infection-control committee
• Extensive patient education
• State-of-the-art operating rooms
• Infection-reducing surgical practices
• Enhanced sterilization methods
• Highly disciplined infection-control practices

“Our study shows that even if you bring a surgeon on staff who is just starting out in their career, that doesn’t mean a patient going to that surgeon is at a greater risk of infection,” Dr. Westrich said. “A rigorous, comprehensive approach to patient care with relentless focus on infection control at every stage provides the greatest protection from infection.”

Source

Grizas AP, Thomson A, Miller A, Westrich GH, Jolissaint. Low Volume Total Knee Arthroplasty Surgeons & Infection Rates: Is it the Surgeon or the Center? (Program Number: 374). Presented at the Annual Meeting of the American Academy of Orthopaedic Surgeons, March 2-6, 2026, New Orleans, Louisiana.