Preoperative dental screening can reduce periprosthetic infections of hip and knee endoprostheses in the first month after surgery: results of a cohort study

Abstract

Purpose The oral cavity and, in particular, potential oral foci might pose a risk of periprosthetic joint infection (PJI). The aim of this cohort study was to determine whether practical preoperative dental screening would reduce the prevalence of early PJI in the first month after surgery. Methods Patients attending a specialized endoprosthesis implantation clinic between 2018 and 2022 were recruited. Two groups were examined. The test group consisted of patients attending the clinic between 2020 and 2022 and who were referred to their family dentist using a standardized form. The comparison group consisted of patients who were treated in the clinic between 2018 and 2020. They were not referred to their family dentist. The two groups were compared for the prevalence of PJI. Univariate analysis followed by multiple logistic regression was performed to confirm risk factors for PJI in this cohort. Results 2560 individuals (test group: 1227, comparison group: 1333) were included. The prevalence of PJI was significantly lower in the test group (0.8% vs. 1.8%, p = 0.04). Multiple logistic regression with PJI as the dependent variable showed that a dental referral was a strong predictor of a lower prevalence of PJI (OR: 0.43, CI95 0.205–0.917, p = 0.03). Male gender was also strongly associated with a higher frequency of PJI (OR: 2.68, CI95 1.32–5.42, p = 0.01). Age (OR: 1.06, CI95 1.01–1.10, p = 0.01) and BMI (OR: 1.11, CI95 1.05–1.17, p < 0.01) had little effect on the risk of PJI. Conclusion Dental referral using a standardized form can reduce the prevalence of early PJI. Accordingly, orthopedists and dentists should collaborate in this practical way.

A Proposal for a Multidisciplinary Integrated Oral Health Network for Patients Undergoing Major Orthopaedic Surgery (IOHN-OS)

“…A disruption of this balance due to the worsening of the hosts’ strength of constitution or changes in the oral environment can lead to bacterial overgrowth, aspiration pneumonia, and translocation to other tissues [ 42 ]. It has been a common belief for more than thirty years now that infection foci in the oral cavity at the time of major orthopaedic surgery may increase the risk of periprosthetic joint infection (PJI) [ 43 ]. Intermittent/persistent bacteraemia from dental infections is known to be a source of haematogenous seeding, although the odontogenic aetiology of the infection would remain complex to demonstrate [ 44 ].…”

“…A similar costly burden may arise when a transversal dental referral with oriented therapy before surgery is imposed by the hospital [ 41 ]. The IOHN-OS will need to be more sustainable [ 43 ], perhaps providing different degrees of support through the allocation of more comprehensive and in-depth resources to more at-risk and/or vulnerable patients (i.e., health equity). This could also help overcome eventual dental system decay and dentist shortages.…”