Over the next several decades, demand for total joint arthroplasty is expected to grow exponentially. At the same time, both the risk and rate of prosthetic joint infection (PJI) are rising. The experts will agree that the practice-related opportunity for improvement in surgical site infection (SSI) is likely exhausted. To prevent infection-related complications that can be devastating for both patients and surgeons, new pathways for improvement are needed. Over 60 years of evidence supports the contribution of airborne contamination to SSI. Studies have shown that the presence of a foreign body can reduce the number of organisms needed to cause an infection by a factor of 100,000. However little, if any, innovation in management of airborne contamination for the operating room (OR) has occurred since the 1970s. In 2017, based on a growing body of evidence, CDC withdrew its recommendation in favor of Laminar Air Flow (LAF) ventilation for infection sensitive surgery and the WHO issued a conditional recommendation that LAF should not be used for joint arthroscopy. These developments suggest that new alternatives are needed. Temperature-controlled Airflow (TcAF), is a novel ventilation technology designed to overcome the limitations of conventional ventilation and improve the comfort of surgical personnel. The presenters will provide an overview of airborne contamination and SSI/PJI, compare the efficacy of different ventilation concepts in managing airborne bioburden, describe the science behind TcAF, contrast U.S. standards for OR air quality with those emerging in Europe and share results of a pilot study which demonstrated statistically significant reduction in PJI attributable to installation of a TcAF system.