The hypotheses of oral disease‐associated perioprosthetic joint infections to understand the role of oral health for endoprostheses ‐ a narrative review

Abstract

AimsPeriprosthetic infections are a severe complication, causing enormous morbidity. The role of oral diseases in the development of such infections has been discussed controversially, showing a large discrepancy between prevalence of oral foci and infections of endoprostheses (EP). This narrative review aimed in explaining and discussing two hypotheses for the occurrence of oral disease‐associated EP infections.Methods and ResultsThe hypotheses include two mechanisms. (1) In case of an acute exacerbation during the early healingperiod after EP surgery (first 3 months). (2) Coincidental in the context of late EP infections (after successful initial healing), where an initial periprosthetic inflammation can be colonized secondarily by oral microorganisms. In both settings,oral foci are not primarily causative for EP infection, but represent an important reservoir for EP colonization, while the immunological conditions (locally and systemically) are crucial for the onset of an EP infection. As potential consequence, patients with risk factors should be orally rehabilitated prior to EP surgery. Usage of antibiotic prophylaxis during the first 3 months after EP implantation (initial healing period) might be considered, but has no reliable evidence. To avoid morbidity of patients, radical dental clearance is unfavorable for the respective patients.ConclusionAltogether, patients with EP should receive increased attention from the dental perspective alongside with dental preventive measures, because they show a high dental and periodontal treatment need.

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

“…There is also a recognised lack of professionals trained in the care of geriatric patients [ 47 ]. The notable gap regarding preventive or corrective treatments before surgery has led the current practice to predominantly focus on a few post-operative actions, such as the use of antibiotic prophylaxis during the initial healing period [ 48 ]. However, there is room for more comprehensive initiatives.…”