Clean Air, Safe Joints: Optimizing Operating Theatre Air Quality to Reduce Surgical Site and Periprosthetic Joint Infections

Abstract

Periprosthetic joint infection (PJI) remains one of the most devastating complications of total joint arthroplasty (TJA), with profound clinical, economic and psychosocial consequences. While modern operating theatres are designed to reduce microbial load, there remains ongoing debate about the role of laminar airflow (LAF), turbulent ventilation, high-efficiency particulate air (HEPA) systems, ultraviolet adjuncts and surgical helmet systems (SHS) in mitigating infection risk. This narrative review synthesizes current evidence on airborne contamination, environmental controls and adjunctive measures in orthopaedic theatres. It highlights key advances in monitoring (e.g., particle counts vs. microbiological sampling), the impact of human behaviour on contamination and integrates findings with patient risk factors, operative efficiency and seasonality. It further examines economic and regulatory perspectives, providing a holistic framework for future directions in infection prevention.