Total joint arthroplasty is increasingly common in the US, with an expected rise in periprosthetic joint infection (PJI). Limited evidence exists of PJI risk in new primary arthroplasty in patients on chronic suppression for prior PJI. Due to a lack of evidence examining this population, shared decision-making must be informed by medical comorbidities and patient-related risk factors, infectious history, and the current evidence of PJI treatment and infection control measures.