Single-use surgical gowns are associated with an increased rate of periprosthetic joint infection : analysis of 9,239 primary hip and knee arthroplasties from a single centre

Periprosthetic joint infection (PJI) remains a serious complication of arthroplasty, associated with increased morbidity, mortality, and healthcare costs. While patient-related and procedural risk factors are well established, the effect of surgical gown type on infection risk is unclear. Single-use surgical gowns are often used due to their perceived superior sterility in the absence of clear evidence. The purpose of this study was to determine the effect of single-use compared with reusable gown use on the incidence of PJI in the 12 months following primary hip and knee arthroplasty. Between January 2015 and September 2023, 9,239 consecutive primary elective hip and knee arthroplasties were performed at our institution. Data were obtained from a prospectively maintained local registry aligned with the UK Health Security Agency Surgical Site Infection database and National Joint Registry, and combined with surgeon gown preference data. A retrospective logistic regression was undertaken to evaluate the association between gown type and PJI in the 12 months after surgery, adjusting for age, sex, BMI, diabetes, and chronic obstructive pulmonary disease (COPD). A total of 76 infections (0.82%) were identified, comprising 49/5,024 knees (0.98%) and 27/4,215 hips (0.64%). Infection occurred more frequently in the single-use gown group (n = 4,314; 1.0%) than in the reusable gown group (n = 4,925; 0.6%; p = 0.017). Single-use gowns were associated with higher odds of infection (adjusted odds ratio (OR) 1.73 (95% CI 1.09 to 2.76); p = 0.020). Use of single-use surgical gowns was independently associated with an increased odds of PJI following primary hip and knee arthroplasty in the 12 months after surgery in our institution. This finding highlights the need for further studies exploring the causal factors contributing to this outcome.