Background We aimed to determine symptomatic COVID-19 rates within one month of elective arthroplasty for vaccinated individuals and to determine whether vaccination guarantees protection against COVID-19 after arthroplasty (Primary outcome). In addition, the 90-day surgical complications were compared to an unvaccinated group (secondary outcome). Methods A prospective cohort study was conducted on elective joint arthroplasty patients at three tertiary hospitals in two major cities in our country. The outcomes of the COVID-19 vaccinated group were assessed between October 2021 and March 2022. 90-day surgical complications were compared with a historical cohort of unvaccinated patients treated earlier in the pandemic (April 2020 to March 2021). Results The study included 1717 consecutive patients: 962 vaccinated and 755 unvaccinated. In the vaccinated group, 38 patients (3.9%) contracted COVID-19, four (10.5%) were hospitalized again, and none required Intensive care unit (ICU) admission. Multivariate logistic regression analysis revealed that COVID-19 positive cases are more likely to be female (OR = 12.5), had visitors to the home (OR = 4.7), and longer stays in the hospital (OR = 1.2) than COVID-19 negative cases. Compared to unvaccinated patients, the postoperative COVID-19 rate was not significantly different (3.9% vs. 2.4%, P = 0.07). The incidence of surgical complications was similar between the two groups (P > 0.05). Conclusions The vaccination does not provide a guarantee that a patient will not contract COVID-19 following their arthroplasty surgery, especially in a region with a high rate of COVID-19. We believe reasonable COVID-19 precautions peri-operatively may be warranted even in vaccinated patients.