Dental procedures not associated with increased periprosthetic joint infections for knee arthroplasty

1. In this nationwide, population-based retrospective cohort study, dental procedures did not increase the risk of periprosthetic joint infections (PJI) in patients who have undergone primary and revision total knee arthroplasty (TKA).

2. Prophylactic antibiotics in these patients did not reduce the PJI risk, while posttraumatic arthritis was associated with PJI.

Evidence Rating Level: 2 (Good)

The efficacy of prophylactic antibiotics before dental procedures to prevent PJI post-total joint arthroplasty (TJA) remains uncertain despite multiple guideline revisions. Surgeons debate concerns about infection and antibiotic overuse. This nationwide, population-based, retrospective, comparative study used data from the Health Insurance Review and Assessment Service in South Korea from 2009 to 2019 to examine whether dental procedures increase the risk of PJI in TKA patients and assess the effect of prophylactic antibiotics. A total of 591,602 patients who underwent unilateral primary and revision TKA, had undergone a dental procedure at least 1 year after their index surgery, and had at least 2 years follow-up after the dental procedures, were enrolled in the study. 530,156 patients (mean age [SD], 68 [8]; 86% female) comprised the nondental cohort and 61,446 patients (mean age [SD], 71 [8]; 87% female) comprised the dental cohort, which was further stratified into prophylactic antibiotics and nonprophylactic groups. To compare cohorts, propensity score matching was used to control for covariates associated with PJI risk. Dental procedures did not increase the risk of PJI after primary or revision total knee arthroplasty TKA. The adjusted hazard ratio (HR) for primary TKA was 1.56 (95% CI 0.30 to 8.15; p = 0.60), and for revision TKA was 1.74 (95% CI 0.90 to 3.34; p=0.10). Prophylactic antibiotic use did not increase PJI risk after either primary (adjusted HR 1.28 [95% CI 0.30 to 5.42]) or revision (adjusted HR 0.74 [95% CI 0.45 to 1.23]; p = 0.25) TKA. While the type of surgery and prophylactic antibiotic usage did not impact PJI incidence after dental procedures, posttraumatic arthritis was significantly associated with PJI (adjusted HR 4.54, p = 0.046). Overall, this study suggests that dental procedures do not increase the risk of PJI for up to 2 years after dental procedures in patients who underwent primary or revision TKA and does not support the use of prophylactic antibiotics in these patients.

Click to read the study in Clinical Orthopaedics and Related Research

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