NEW ORLEANS--(BUSINESS WIRE)--Mar 4, 2026--
A retrospective study by Hospital for Special Surgery (HSS) investigators found that infection rates at a high-volume academic orthopedic center following total knee arthroplasty (TKA) are uniformly low regardless of individual surgeon volume. These findings challenge the long-held belief that a surgeon’s experience, not the institution’s, drives safety outcomes. The research team shared their study results in a presentation at the American Academy of Orthopedic Surgeons (AAOS) 2026 Annual Meeting.
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TKA, also known as total knee replacement, is one of the most common elective surgeries in the United States, with over 700,000 cases performed each year. In spite of advances in surgical techniques and antibiotic regimens, infection following TKA remains a devastating complication that has led to a greater focus on controllable risk factors.
“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,” says senior author Geoffrey H. Westrich, MD, hip and knee 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 orthopedic center that places great importance on infection prevention.
“At HSS, we perform thousands of joint replacements each year and we have an incredibly robust infection prevention program that has resulted in infection rates that are among the lowest in the nation,” Dr. Westrich continues. “However, the biggest problem with infection research is that because our rates are so low, it’s hard to isolate the impact of individual surgeon volume from the many institutional factors that influence outcomes.”
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 three categories: low (<50 cases/year), high (50–250 cases/year), and 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 study found 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.
Dr. Westrich notes that infection rates for TKA across the surgeon volume groups are extremely low compared to other hospitals in New York State. “Our HSS infection rates, which range from 0.1% to 0.3%, are among the lowest in the New York State and in our country,” he says. “At other New York State hospitals, infection rates can be as high as 2.0% or ten times higher than our institution.”
“Our findings demonstrate that at a high-volume academic orthopedic center, infection rates following total knee replacement remain uniformly low regardless of individual surgeon volume,” says Dr. Westrich. “This flies in the face of what we’ve been told historically about surgeon volume and infection rates. It’s not just the surgeon, it’s the institution that drives safety.”
“At HSS, controlling the risk of infection is among our highest priorities and most important accomplishments,” explains Dr. Westrich. “Our low infection rates are achieved with a robust infection-control committee, extensive patient education, state-of-the-art operating rooms, infection-reducing surgical practices, enhanced sterilization methods, and highly disciplined infection-control practices. Together, these factors outweigh the volume of the individual surgeon.”
To improve patient safety and quality care at orthopedic centers, Dr. Westrich emphasizes the importance of strengthening institutional infrastructure and quality-improvement programs, rather than limiting low-volume surgeons’ access to TKA. “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. A rigorous, comprehensive approach to patient care with relentless focus on infection control at every stage provides the greatest protection from infection.”
Authors: Josef Jolissaint, MD; Andrew Thomson, BA; Alexandra Grizas, MPH; Andy Miller, MD; and Geoffrey H. Westrich, MD
About HSS
HSS is the world’s leading academic medical center focused on musculoskeletal health. At its core is Hospital for Special Surgery, nationally ranked No. 1 in orthopedics (for the 16th consecutive year), No. 3 in rheumatology by U.S. News & World Report (2025-2026), and the best pediatric orthopedic hospital in NY, NJ and CT by U.S. News & World Report “Best Children’s Hospitals” list (2024-2025). Founded in 1863, the Hospital has the lowest readmission rates in the nation for orthopedics, and among the lowest infection and complication rates. HSS was the first in New York State to receive Magnet Recognition for Excellence in Nursing Service from the American Nurses Credentialing Center five consecutive times. An affiliate of Weill Cornell Medical College, HSS has a main campus in New York City and facilities in New Jersey, Connecticut and in the Long Island and Westchester County regions of New York State, as well as in Florida. In addition to patient care, HSS leads the field in research, innovation and education. The HSS Research Institute comprises 20 laboratories and 300 staff members focused on leading the advancement of musculoskeletal health through prevention of degeneration, tissue repair and tissue regeneration. In addition, more than 200 HSS clinical investigators are working to improve patient outcomes through better ways to prevent, diagnose, and treat orthopedic, rheumatic and musculoskeletal diseases. The HSS Innovation Institute works to realize the potential of new drugs, therapeutics and devices. The HSS Education Institute is a trusted leader in advancing musculoskeletal knowledge and research for physicians, nurses, allied health professionals, academic trainees, and consumers in more than 165 countries. The institution is collaborating with medical centers and other organizations to advance the quality and value of musculoskeletal care and to make world-class HSS care more widely accessible nationally and internationally. www.hss.edu.
A retrospective study by Hospital for Special Surgery (HSS) investigators, led by Geoffrey H. Westrich, MD, hip and knee surgeon at HSS, found that infection rates at a high-volume academic orthopedic center following total knee arthroplasty are uniformly low regardless of individual surgeon volume.
OBBUERGEN, Switzerland (AP) — Iran’s foreign minister early Monday praised Pakistan and Qatar for their mediation after talks in Switzerland, saying that they “delivered major progress.”
Abbas Araghchi wrote the message on X.
Pakistan, Qatar and Iran all have acknowledged the end of the first round of high-level talks. The U.S. hasn’t comment.
In his message, Araghchi said the first real test of the understandings reached would be a deconfliction method created over the fighting between Israel and the Iranian-backed militia Hezbollah in Lebanon.
Iran has tied success in the talks to the end of the fighting there. Israel insists it will continue to occupy Lebanese territory and that it must have a free hand to fight Hezbollah, which has launched attacks into northern Israel.
THIS IS A BREAKING NEWS UPDATE. AP’s earlier story follows below.
High-level negotiations in Switzerland seeking a permanent end to the Iran war have ended, mediators said early Monday, while technical talks will go on there for the rest of the week.
Pakistan and Qatar, the two mediators there, issued a statement making the announcement. The United States did not immediately acknowledge it. Iran, through Foreign Ministry spokesman Esmail Baghaei speaking to the state-run IRNA news agency, said “good progress was made.”
The talks mark the start of diplomacy in a 60-day process seeking to reach a permanent deal over the Iran war. But fighting between Israel and the Iranian-back militia Hezbollah in Lebanon continues to threaten the diplomacy.
Meanwhile, Iran insisted it had again shut the Strait of Hormuz over the weekend, the narrow mouth of the Persian Gulf crucial to energy shipments. The U.S. said traffic continued.
Negotiators worked through the night after high-level U.S.-Iran talks on their interim deal to end the war had a tense start Sunday in Switzerland, when Tehran took offense at U.S. President Donald Trump's threat to attack and his warning that Iran's president should watch what he says.
The comments from afar — on social media and to news outlets — complicated efforts by Vice President JD Vance and mediators Pakistan and Qatar to keep Iran engaged in discussions meant to address thorny issues like Tehran's nuclear program, the Strait of Hormuz and the unfreezing of billions of dollars in Iranian assets.
Before anything, however, Iran wants to discuss Lebanon, where Israel's military has been fighting the Iranian-backed Hezbollah militant group, since the deal halts conflict on all fronts.
“Iran must immediately stop their highly paid PROXIES in Lebanon from causing trouble,” Trump said on social media. “If they don’t, we’ll hit Iran very hard again, just like we did last week, only harder!!!”
“They would do better to be careful about their statements," Iran's lead negotiator, Mohammad Bagher Qalibaf, said on X after Trump's comments. "Our armed forces are prepared to respond to them in a different manner. They may keep talking, it is we who act.”
Iranian state media said talks had entered a “difficult phase” and recessed after the “publication of an insulting message by the U.S. President.” The Iranian delegation then met with Qatari mediators and left the negotiating site, state media said.
Vance and U.S. negotiators including Steve Witkoff and Jared Kushner, Trump’s son-in-law, had met with Qalibaf and Foreign Minister Abbas Araghchi for what Iranian state media said was about 80 minutes.
It was not clear when they might meet again. Negotiators were anticipating working through the night, according to a senior U.S. diplomat engaged in the talks.
The diplomat, speaking on condition of anonymity to describe private discussions, said talks included clarifying what Iran meant by recent statements about the Strait of Hormuz. Negotiators also discussed “mechanisms” to ensure the strait remains open and that a ceasefire in southern Lebanon is enforced, along with “robust” discussions on the nuclear issue.
Negotiators are in a 60-day sprint to reach an agreement on the technical details that hold massive implications for the world economy and global security.
“The question before us now is how much more can we accomplish together? Can we turn over a new leaf?” Vance said as the talks began, and asked whether they could “change relations in the Middle East permanently.”
The U.S. wants Iran locked into negotiations over its nuclear program amid concerns it may be used for military purposes, which Iran denies. Vance also wants Tehran to commit to keeping open the Strait of Hormuz, which Iran on Saturday claimed to close. The U.S. has disputed that, saying shipping traffic continued Sunday.
But Iranian Foreign Ministry spokesperson Esmail Baghaei told the state news agency that Tehran first wants talks to focus on the conflict in Lebanon.
A renewed ceasefire in Lebanon, brokered on Saturday, appeared to be holding, and Israel's military said it would lift movement restrictions for residents near the border with Lebanon on Monday morning — another sign of calm.
But neither Israel nor Hezbollah is a signatory to the U.S.-Iran deal, and Israeli Prime Minister Benjamin Netanyahu has vowed to keep his forces in southern Lebanon until any threat to Israel is eliminated. Hezbollah has refused to halt attacks unless Israel commits to withdrawing.
The agreement signed by Trump and Iranian President Masoud Pezeshkian immediately allows Tehran to sell its oil freely and paves the way for Iran to tap into billions of dollars in assets that are currently frozen. A member of Iran's negotiating team told state television that draft wording was reached about “temporary sanctions waivers for oil and petroleum derivatives."
The agreement also calls for Iran to dilute its stockpile of highly enriched uranium, believed to be buried under nuclear sites that were targeted in U.S. strikes a year ago.
Pezeshkian, however, declared Sunday that "we will never back down from the right to enrich uranium, and the other side is also forced to accept it,” according to Iran’s state media.
Trump, in a telephone interview with Fox News, later warned that the Iranian president should watch what he says and threatened to take over Iran, in comments relayed by a Fox correspondent.
Iran had cautiously approached the talks given its previous experience with U.S. negotiations on the nuclear issue, which twice in the past year were interrupted by military strikes.
Vance has said he planned to be in Switzerland for “a day or two,” leaving much of the detailed negotiations to be led by Witkoff and Kushner. His role in the talks has heightened scrutiny at a time when he's considering a 2028 presidential campaign.
Trump and Vance have come under searing criticism from parts of their own party for the deal, with Republican hard-liners unfavorably likening it to the nuclear agreement signed by the Obama administration that Trump and Republicans have insisted did nothing to terminate Iran’s nuclear program.
The new agreement says commercial vessels can pass through the Strait of Hormuz for 60 days without charge, but does not preclude future fees imposed by Iran. Trump made his own threat Saturday to levy U.S. tolls if there is no deal with Iran in 60 days, insisting that the money would be for “services rendered as the Guardian Angel to the countries of the Middle East.”
The Trump administration has been working to reassure global markets that the war has been merely a blip on oil prices, as Americans complain about high gasoline prices ahead of peak summer travel. After the deal was announced, oil futures dropped almost 8%.
Markets are expected to closely track the progress of talks when they open for trading Sunday evening.
Kim reported from Washington. Associated Press writers Munir Ahmed in Islamabad, Amir Vahdat in Tehran, Iran, and Melanie Lidman in Tel Aviv, Israel, contributed to this report.
A sign for the Lake Lucerne Summit at the Bürgenstock during a meeting between U.S. Vice President JD Vance and Pakistan's Prime Minister Shehbaz Sharif for high-level talks aimed at advancing a deal to end the Middle East conflict, in Obbuergen, Switzerland, Sunday, June 21, 2026. (Nathan Howard/Pool Photo via AP)
U.S. Vice President JD Vance waits to meet with Pakistan's Prime Minister Shehbaz Sharif during high-level talks aimed at advancing a deal to end the Middle East conflict, at the Bürgenstock Resort in Obbuergen, Switzerland, Sunday, June 21, 2026. (Nathan Howard/Pool Photo via AP)
U.S. Vice President JD Vance, left, reacts next to U.S. President Donald Trump's envoys Steve Witkoff, second right, and Jared Kushner, right, while waiting to meet with Pakistan's Prime Minister Shehbaz Sharif for high-level talks aimed at advancing a deal to end the Middle East conflict, at the Bürgenstock Resort in Obbuergen, near Lucerne, in Switzerland, Sunday, June 21, 2026. (Nathan Howard/Pool Photo via AP)
U.S. Vice President JD Vance, left, reacts next to U.S. President Donald Trump's envoys Steve Witkoff, second right, and Jared Kushner, right, while waiting to meet with Pakistan's Prime Minister Shehbaz Sharif for high-level talks aimed at advancing a deal to end the Middle East conflict, at the Bürgenstock Resort in Obbuergen, near Lucerne, in Switzerland, Sunday, June 21, 2026. (Nathan Howard/Pool Photo via AP)
Iran’s Foreign Minister Abbas Araghchi, left, and Switzerland's Foreign Minister Federal councillor Ignazio Cassis, right, shake hands at bilateral discussions at the Buergenstock resort in Obbuergen, near Lucerne, Switzerland, Sunday, June 21, 2026. (Urs Flueeler/Keystone via AP)
A Swiss Army Helicopter flies around the Buergenstock resort in Obbuergen, near Lucerne, Switzerland, Sunday, June 21, 2026. (Urs Flueeler/Keystone Pool via AP)
U.S. Vice President JD Vance, right, meets with Pakistan's Prime Minister Shehbaz Sharif, during high-level talks aimed at advancing a deal to end the Middle East conflict, at the Bürgenstock Resort in Obbuergen, near Lucerne, in Switzerland, Sunday, June 21, 2026. (Nathan Howard/Pool Photo via AP)
A convoy with U.S. Vice President JD Vance arrives at the Bürgenstock Resort in Obbuergen, near Lucerne, in Switzerland Sunday, June 21, 2026. (Urs Flueeler/Keystone, Pool Photo via AP)
A convoy with U.S. Vice President JD Vance arrives at the Bürgenstock Resort in Obbuergen, near Lucerne, in Switzerland Sunday, June 21, 2026. (Urs Flueeler/Keystone, Pool Photo via AP)
A convoy with U.S. Vice President JD Vance arrives at the Bürgenstock Resort in Obbuergen, near Lucerne, in Switzerland Sunday, June 21, 2026. (Urs Flueeler/Keystone, Pool Photo via AP)
A convoy with U.S. Vice President JD Vance arrives at the Bürgenstock Resort in Obbuergen, near Lucerne, in Switzerland Sunday, June 21, 2026. (Urs Flueeler/Keystone, Pool Photo via AP)
Iranian Foreign Minister Seyyed Abbas Araghchi, center, arrives at the Buergenstock resort in Obbuergen, near Lucerne, Switzerland, early Sunday, June 21, 2026. (Urs Flueeler/Keystone, Pool via AP)
Air Force Two, with Vice President JD Vance and second lady Usha Vance on board, departs Joint Base Andrews, Md., Saturday, June 20, 2026, en route to Switzerland. (Elizabeth Frantz/Pool Photo via AP)
Vice President JD Vance speaks to reporters at Joint Base Andrews, Md., Saturday, June 20, 2026, en route to Switzerland. (Elizabeth Frantz/Pool Photo via AP)
