Higher Onset of Periprosthetic Joint Infections in Patients With Teeth Compared to Those Without Teeth

TL;DR

Patients with teeth have a higher risk of late joint infections after surgery compared to those without teeth, likely due to bacteria entering the bloodstream from the mouth.

Contribution

This study identifies teeth as a potential risk factor for late periprosthetic joint infections.

Findings

Patients with teeth had a 2.14% infection rate, compared to 0.78% in edentulous patients.

Infections in patients with teeth occurred more frequently one month or longer after surgery.

Chronic kidney disease was more common in patients who developed periprosthetic joint infections.

Abstract

Introduction: Bacteria can enter the bloodstream through simple actions such as brushing teeth, flossing, and even chewing food, increasing the chance of hematogenous seeding of prosthetic joints. Antibiotics before dental work in patients with orthopedic hardware is a topic of debate because of concerns for antibiotic resistance. Patients with dentures theoretically avoid this risk due to the lack of teeth and their maintenance. Most periprosthetic joint infections (PJIs) that occur in the first six months after surgery are due to wound infection, whereas late PJIs are more commonly caused by hematogenous seeding.

Materials and methods: Charts from patients who received primary total joint arthroplasty were interrogated for the condition of their teeth at the time of operation. If the patient had a PJI, the time from surgery and the organism responsible were noted. Multivariate linear regressions were performed for statistical analysis to compare rates of dental status, infection, comorbidities, and demographics.

Results: From the 1,500 charts reviewed, patients with teeth and edentulous had similar rates of comorbidities. PJI patients had higher rates of chronic kidney disease than patients who did not have the infection. The overall rate of infections in patients with teeth was 2.14%, close to the national average. The rate of infection in patients without teeth was 0.78%. Patients with teeth have a higher rate of infection one month or longer from surgery than edentulous patients.

Conclusions: There was an increased infection rate in patients with teeth at six months and greater since the primary total joint arthroplasty. The organisms responsible for many of the PJIs are commonly found in the mouth of humans. Having teeth is a potential risk factor for late PJI.

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