Views: 0 Author: Site Editor Publish Time: 2026-08-13 Origin: Site
Periprosthetic joint infection (PJI) remains one of the most serious complications following total hip arthroplasty (THA) and total knee arthroplasty (TKA). Although relatively uncommon, PJI can lead to prolonged hospitalization, repeated revision surgery, impaired quality of life, substantial healthcare costs, and increased mortality.
Surgical gowns are an important component of the operating-room barrier system designed to reduce microbial contamination during joint replacement surgery. Traditionally, single-use disposable gowns have been widely adopted because of their perceived advantages in sterility and consistency. However, growing concerns about the environmental impact of disposable medical products have increased interest in modern reusable surgical gowns.
A recently published study in the Bone & Joint Journal evaluated whether the type of surgical gown used during primary hip and knee arthroplasty was associated with the risk of PJI within 12 months after surgery.
The findings were unexpected: patients operated on while the surgical team used single-use gowns had a higher observed rate of PJI than those operated on using reusable gowns.
Importantly, this observational finding does not establish that disposable gowns directly cause infection. Instead, it identifies an association that warrants further investigation.
PJI is considered one of the most challenging complications in modern joint replacement surgery. Treatment frequently requires prolonged antimicrobial therapy, debridement, implant retention procedures, one- or two-stage revision arthroplasty, or even permanent implant removal in severe cases.
The economic consequences can also be substantial. Treatment of PJI generally requires considerably more healthcare resources than uncomplicated primary arthroplasty or aseptic revision surgery.
Because microorganisms can enter the surgical field through multiple pathways, infection prevention depends on a combination of measures rather than a single intervention. These include:
Appropriate antibiotic prophylaxis
Effective skin antisepsis
Operating-room environmental control
Surgical team behavior and aseptic technique
Appropriate surgical draping
Sterile surgical gowns and gloves
Optimized operating-room ventilation
Proper implant handling
Careful postoperative wound management
The surgical gown therefore represents one component of a much broader infection-prevention strategy.
Single-use surgical gowns are manufactured for one operation and discarded afterward. Their major perceived advantages include standardized manufacturing, predictable barrier characteristics, and elimination of concerns related to laundering and reprocessing.
Reusable surgical gowns, in contrast, are manufactured from durable textile materials and undergo controlled washing, disinfection, inspection, packaging, and sterilization or other validated processing procedures according to institutional protocols.
Modern reusable gowns are substantially different from older textile gown designs. Advances in textile technology have improved:
Fluid resistance
Microbial barrier performance
Fabric durability
Seam construction
Breathability
Comfort
Mechanical strength
Laboratory studies have suggested that appropriately designed reusable gowns can provide barrier protection comparable to, and in some circumstances better than, disposable gowns.
However, laboratory barrier performance does not necessarily translate directly into differences in clinical infection rates.
This distinction is particularly important when interpreting the findings of the present study.
The primary objective of the study was to determine whether the type of surgical gown used during primary hip and knee arthroplasty was associated with the incidence of PJI during the first 12 months after surgery.
The investigators specifically compared:
Single-use surgical gowns
Reusable surgical gowns
The study focused on elective primary hip and knee replacement procedures performed at a single institution over several years.
The researchers also attempted to account for important patient-related factors that could influence infection risk.
Between January 2015 and September 2023, the institution performed 9,239 consecutive elective primary hip and knee arthroplasties.
The study population consisted of patients undergoing:
Primary total hip arthroplasty
Primary total knee arthroplasty
The investigators used a prospective local registry linked with relevant national datasets, including surgical-site infection surveillance information and the National Joint Registry.
Surgical gown preference data were also incorporated into the analysis.
This allowed the researchers to investigate whether gown type was associated with subsequent PJI diagnosed within 12 months following arthroplasty.
Because this was an observational study rather than a randomized clinical trial, differences between patients and surgical teams could potentially influence the observed infection rates.
To reduce the effect of these confounding factors, the investigators performed logistic regression analysis.
The analysis adjusted for several patient characteristics, including:
Age
Sex
Body mass index (BMI)
Diabetes mellitus
Chronic obstructive pulmonary disease (COPD)
After adjustment, the researchers assessed whether the use of single-use surgical gowns remained independently associated with PJI.
This statistical approach strengthens the analysis, but it cannot completely eliminate the possibility of residual confounding inherent to retrospective observational studies.
Among the 9,239 primary arthroplasty procedures, the study identified 76 cases of PJI, corresponding to an overall infection rate of approximately 0.82%.
The infection rates differed between the two major surgical groups:
Total knee arthroplasty: 49 infections among 5,024 procedures — approximately 0.98%
Total hip arthroplasty: 27 infections among 4,215 procedures — approximately 0.64%
These figures demonstrate that PJI remained an uncommon complication, but its clinical importance is substantial because even a relatively small difference in infection rate can have major consequences when applied to thousands of arthroplasty procedures.
The most notable finding was the difference in infection rates according to surgical gown type.
Among procedures performed using single-use gowns:
4,314 procedures were associated with a PJI rate of approximately 1.0%.
Among procedures performed using reusable gowns:
4,925 procedures were associated with a PJI rate of approximately 0.6%.
The difference was statistically significant.
After adjustment for relevant patient characteristics, the use of single-use surgical gowns remained associated with a higher risk of PJI:
Adjusted OR 1.73 (95% CI 1.09–2.76; p = 0.020).
This means that, within this particular cohort and after statistical adjustment, procedures involving single-use gowns demonstrated approximately 73% higher odds of PJI compared with procedures involving reusable gowns.
However, the result should be interpreted as an association rather than proof of causation.
The results challenge the common assumption that disposable gowns necessarily provide superior infection protection simply because they are used only once.
The study raises an important question for orthopedic surgery:
Does a disposable surgical gown actually provide better clinical protection against PJI than a properly processed modern reusable gown?
The answer cannot yet be considered definitive.
The study was conducted at a single institution, and surgical gown selection was influenced by surgeon preference rather than random allocation. Therefore, gown type may have been associated with other differences in surgical practice, operating-room environment, personnel, or surgeon characteristics.
Nevertheless, the findings are important because they highlight the need to evaluate infection-prevention interventions using clinical outcomes, rather than relying exclusively on laboratory testing or assumptions about sterility.
The association between single-use surgical gowns and a higher rate of periprosthetic joint infection (PJI) is clinically interesting, but it should not be interpreted as evidence that disposable gowns directly cause infection.
The study was observational and conducted at a single institution. Surgical gown selection was not randomized, meaning that patients treated with disposable gowns may have differed from those treated with reusable gowns in ways that were not fully captured by statistical adjustment.
Potential confounding factors may include:
Surgeon preference and surgical technique
Operating-room practices
Staff composition
Duration of surgery
Patient complexity
Operating-room traffic
Ventilation characteristics
Changes in infection-control protocols over time
Differences in gown design and processing
Therefore, the reported adjusted odds ratio should be regarded as a signal requiring further investigation rather than a definitive causal relationship.
The biological mechanism behind the observed association remains uncertain.
A surgical gown functions primarily as a barrier between microorganisms carried by healthcare personnel and the sterile surgical field. Its effectiveness depends on several factors rather than whether the gown is disposable or reusable alone.
Important variables include:
Fabric structure
Microbial barrier properties
Fluid resistance
Seam integrity
Gown fit
Permeability during prolonged surgery
Sterilization or processing quality
Correct gowning technique
Modern reusable gowns can provide effective microbial and fluid barriers when they are manufactured, processed, inspected, and maintained according to validated standards.
Consequently, the distinction between single-use versus reusable may be less important than the actual performance and quality-control system surrounding the gown.
The potential advantages of reusable gowns extend beyond environmental sustainability.
A properly managed reusable gown system may provide:
Consistent textile quality
High durability
Repeated validated processing
Reduced dependence on disposable materials
Potentially lower long-term healthcare waste
Reduced environmental impact
Comparable barrier protection when appropriately designed
However, reusable gowns also require strict quality control.
The complete processing chain is important, including:
Collection after surgery
Appropriate transportation
Decontamination
Washing
Inspection
Repair when necessary
Packaging
Sterilization or validated disinfection
Storage and distribution
Failure at any stage could compromise the protective performance of a reusable gown.
Therefore, reusability itself should not be considered either inherently safer or inherently less safe.
Sustainability has become an increasingly important issue in modern healthcare.
Joint replacement surgery involves substantial consumption of:
Surgical gowns
Drapes
Gloves
Packaging
Plastic products
Sterile equipment
Disposable instruments and accessories
Because arthroplasty is performed in large numbers worldwide, even relatively small reductions in disposable materials can have a significant environmental effect.
The increasing use of reusable surgical gowns therefore reflects a broader movement toward sustainable surgical practice.
However, environmental benefits must never come at the expense of patient safety.
The ideal approach is to identify products and systems that simultaneously provide:
Effective infection prevention + reliable clinical performance + environmental sustainability.
For orthopedic surgeons performing total hip arthroplasty (THA) or total knee arthroplasty (TKA), the study reinforces an important principle:
PJI prevention requires a comprehensive system rather than reliance on a single protective device.
Appropriate measures should include:
Evidence-based antibiotic prophylaxis
Proper skin preparation
Appropriate operating-room ventilation
Strict aseptic technique
Effective surgical draping
Proper gown and glove selection
Appropriate implant handling
Minimization of unnecessary operating-room traffic
Optimized surgical duration
Careful postoperative wound management
Changing the gown type alone should not be expected to eliminate PJI.
Instead, gown selection should be considered one component of the overall infection-control strategy.
Feature | Single-Use Surgical Gowns | Reusable Surgical Gowns |
|---|---|---|
Intended use | One procedure | Multiple procedures |
Reprocessing | Not required | Required |
Barrier performance | Depends on product design | Depends on textile and processing |
Quality consistency | Generally standardized | Requires ongoing inspection |
Medical waste | Higher | Lower |
Environmental impact | Generally higher | Potentially lower |
Long-term cost | Potentially higher | Potentially lower |
Processing requirements | Minimal after use | Strict validated processing required |
Infection-control implications | Requires appropriate product selection | Requires appropriate processing and quality control |
This comparison demonstrates why the question should not simply be framed as “disposable or reusable?”
The more clinically relevant question is:
Which gown system provides reliable barrier protection under actual surgical conditions while maintaining appropriate quality control and patient safety?
The findings should not lead surgeons to immediately abandon single-use gowns.
Instead, they highlight several areas that deserve closer attention.
The assumption that disposable automatically means safer is not sufficient evidence for clinical decision-making.
Actual PJI rates and other patient outcomes should be considered when evaluating infection-prevention strategies.
Gown selection should be evaluated alongside surgical technique, environmental control, sterilization procedures, and patient-related risk factors.
Reusable gowns should only be used within validated institutional processing systems.
Damaged, excessively worn, or compromised gowns should be removed from circulation.
The present findings are important but do not establish causality.
Multicenter prospective studies and randomized comparisons would provide stronger evidence.
Several limitations should be considered when interpreting the findings.
The research was conducted at one institution. Infection-control protocols, surgical practices, gown products, and patient populations may differ between hospitals.
Therefore, the results may not be directly generalizable to every arthroplasty center.
Patients were not randomly assigned to disposable or reusable gown groups.
This creates the possibility of residual confounding.
Gown selection was influenced by surgeon preference. Surgeons who prefer different gown types may also differ in surgical techniques or other perioperative practices.
“Single-use gown” and “reusable gown” are broad categories.
Different manufacturers and models can have substantially different:
Fabric structures
Barrier properties
Seam designs
Fluid resistance
Breathability
Durability
Therefore, the findings should not automatically be generalized to every disposable or reusable gown available on the market.
Future studies should ideally include:
Multicenter prospective cohorts
Randomized controlled trials where feasible
Standardized gown specifications
Detailed operating-room environmental data
Microbial contamination measurements
Long-term PJI surveillance
Cost-effectiveness analysis
Life-cycle environmental assessment
Such studies would help determine whether the observed association represents a true causal relationship or reflects other differences in surgical practice.
Current evidence does not prove that single-use gowns directly cause PJI.
The 2026 single-center study found an association between single-use gown use and increased PJI risk after primary hip and knee arthroplasty. However, because the study was observational, causation cannot be established.
There is currently insufficient evidence to conclude that reusable gowns are universally safer.
Modern reusable gowns can provide strong barrier protection when properly designed and processed. However, clinical infection outcomes depend on many factors beyond gown type.
No.
The study does not provide sufficient evidence to recommend abandoning disposable gowns.
Hospitals should evaluate their own infection rates, gown specifications, processing systems, costs, sustainability goals, and infection-control protocols before changing gown policies.
Potentially, yes.
Because reusable gowns are designed for multiple uses, they can reduce the amount of disposable textile waste generated by surgery. However, their environmental impact also depends on laundering, transportation, water consumption, energy use, and sterilization requirements.
A complete life-cycle assessment is therefore necessary.
PJI prevention is multifactorial.
Important components include appropriate antimicrobial prophylaxis, skin preparation, aseptic technique, operating-room environmental control, proper surgical draping, appropriate implant handling, and optimized perioperative management.
No individual gown or device can independently eliminate the risk of PJI.
The study provides an important reminder that established clinical assumptions should continue to be tested against real-world patient outcomes.
The increasing emphasis on sustainable healthcare creates an opportunity to reconsider commonly used disposable products in orthopedic surgery.
However, sustainability should not be pursued simply by replacing disposable products with reusable alternatives. Instead, healthcare systems should evaluate the complete clinical and environmental performance of each product.
Future research should focus on determining whether modern reusable gowns can provide equivalent or superior protection against microbial contamination and PJI while reducing environmental impact and healthcare costs.
The most important question is therefore not whether a surgical gown is disposable or reusable.
It is whether the entire gown system reliably protects the sterile surgical field and contributes to safe patient outcomes.
The analysis of 9,239 primary hip and knee arthroplasties found that the use of single-use surgical gowns was associated with a higher rate of PJI within 12 months compared with reusable gowns.
The observed adjusted odds ratio was 1.73, although the observational study design means that a causal relationship cannot be established.
These findings challenge the assumption that disposable surgical gowns necessarily provide superior clinical protection and highlight the importance of evaluating surgical gowns according to real-world clinical outcomes.
At the same time, the study should not be interpreted as definitive evidence that reusable gowns are universally safer.
For orthopedic surgery, the future of infection prevention will likely depend on a combination of:
evidence-based infection control + high-performance surgical barriers + validated processing systems + sustainable healthcare practices.
Further multicenter and prospective research is required before definitive recommendations regarding surgical gown selection can be made.
