Associations Between Preoperative Seasonal Vaccination and Complications After Total Joint Arthroplasty

Background Vaccinations against common respiratory pathogens are recommended for the general population. However, associations between respiratory vaccinations and outcomes following total joint arthroplasty (TJA) have not been investigated. Methods Using a national registry, 595,339 adults who underwent TJA were identified. Patients were stratified by influenza vaccination within three months before surgery and COVID-19 vaccination within three months of surgery or any time prior. Propensity-score matching controlled for demographics, comorbidities, and recent infections. Primary outcomes included 90-day and 2-, 3-, and 4-year rates of all-cause revision, periprosthetic joint infection (PJI), aseptic loosening, and periprosthetic fracture. The secondary outcomes included 90-day medical complications and mortality. Results Influenza vaccination within three months of TJA was associated with higher 90-day medical complications, including deep vein thrombosis (odds ratio (OR) 1.38, 95% confidence interval (CI) 1.13 to 1.69) and pneumonia (OR 1.51, 95% CI 1.18 to 1.95), as well as PJI (OR 1.24, 95% CI 1.03 to 1.48) at four years. In contrast, COVID-19 vaccination within three months of TJA was associated with lower odds of pneumonia (OR 0.62, 95% CI 0.39 to 0.97) at 90 days compared to unvaccinated controls. At two years postoperatively, COVID-19 vaccination any time before TJA was associated with lower odds of PJI (OR 0.77, 95% CI 0.67 to 0.90) that persisted at three and four years, and lower odds of all-cause revision at four years (OR 0.81, 95% CI 0.71 to 0.92). Conclusions A COVID-19 vaccination before TJA was associated with lower odds of pneumonia at 90 days and PJI at two, three, and four years. In contrast, recent influenza vaccination was associated with higher odds of pneumonia and DVT at 90 days and PJI at four years. These findings highlight potential associations between vaccine type, timing, and postoperative outcomes, but should be interpreted as observational rather than proof of causality.