Advertisement

The Importance of Oral History: Does Dental Implant Placement or Caries One Year Before or After Primary Total Knee Arthroplasty Increase Medical Complications and Periprosthetic Joint Infections?

Published:October 14, 2022DOI:https://doi.org/10.1016/j.arth.2022.10.013

      Abstract

      Background

      Consensus regarding prior dental problems on the outcomes of total knee arthroplasty (TKA) patients is lacking. Therefore, our objectives were to determine the association of dental caries or dental implant placement in TKA patients on the following: (1) medical complications; (2) health care utilization (lengths of stay and readmissions); (3) implant-related complications; and (4) expenditures.

      Methods

      A retrospective query was performed using an administrative claims database for 3 patient cohorts undergoing primary TKA from 2010 to 2020. Patients who had a history of dental caries or implant placement 1 year prior to TKA (n = 1,466) and 1 year after TKA (n = 1,127) were case-matched to patients who did not have a dental history by age and comorbidities. Outcomes included 90-day complications, health care utilization parameters, 2-year implant complications, and expenditures. Logistic regression models computed odds ratios (OR) of complications and readmissions. P values less than 0.005 were significant.

      Results

      Patients who had a dental implant placement prior to TKA had higher frequency of complications (20.05 versus 14.01%; OR: 1.53, P < .0001), including myocardial infarctions (2.52 versus 1.23%; OR: 2.08, P = .0002) and pneumonia (2.52 versus 1.24%; OR: 2.06, P = .0002). Lengths of stay (3.28 versus 2.98 days; P = .255), readmission rates (4.71 versus 4.28%; P = .470), and implant-related complications including periprosthetic joint infections (3.14 versus 2.63%; OR: 1.20, P = .279) were similar between patients lacking dental history. Expenditures were higher in patients who had a postoperative and preoperative dental history ($19,252 versus $19,363 versus 17,980; P < .001).

      Conclusion

      Dental caries or implant placement may reflect overall worse medical condition resulting in more complications and higher costs after TKA. Dental history screening preoperatively may assist arthroplasty surgeons in minimizing complications.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to The Journal of Arthroplasty
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Sloan M.
        • Premkumar A.
        • Sheth N.P.
        Projected volume of primary total joint arthroplasty in the U.S., 2014 to 2030.
        J Bone Joint Surg Am. 2018; 100: 1455-1460https://doi.org/10.2106/JBJS.17.01617
        • Kurtz S.
        • Ong K.
        • Lau E.
        • Mowat F.
        • Halpern M.
        Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030.
        J Bone Joint Surg Am. 2007; 89: 780-785https://doi.org/10.2106/JBJS.F.00222
        • Koh C.K.
        • Zeng I.
        • Ravi S.
        • Zhu M.
        • Vince K.G.
        • Young S.W.
        Periprosthetic joint infection is the main cause of failure for modern knee arthroplasty: an analysis of 11,134 knees.
        Clin Orthop Relat Res. 2017; 475: 2194https://doi.org/10.1007/S11999-017-5396-4
        • Dalury D.F.
        • Pomeroy D.L.
        • Gorab R.S.
        • Adams M.J.
        Why are total knee arthroplasties being revised?.
        J Arthroplasty. 2013; 28: 120-121https://doi.org/10.1016/J.ARTH.2013.04.051
        • Sharkey P.F.
        • Lichstein P.M.
        • Shen C.
        • Tokarski A.T.
        • Parvizi J.
        Why are total knee arthroplasties failing today--has anything changed after 10 years?.
        J Arthroplasty. 2014; 29: 1774-1778https://doi.org/10.1016/J.ARTH.2013.07.024
        • Schroer W.C.
        • Berend K.R.
        • Lombardi A.V.
        • Barnes C.L.
        • Bolognesi M.P.
        • Berend M.E.
        • et al.
        Why are total knees failing today? Etiology of total knee revision in 2010 and 2011.
        J Arthroplasty. 2013; 28: 116-119https://doi.org/10.1016/J.ARTH.2013.04.056
        • Crowe B.
        • Payne A.
        • Evangelista P.J.
        • Stachel A.
        • Phillips M.S.
        • Slover J.D.
        • et al.
        Risk factors for infection following total knee arthroplasty: a series of 3836 cases from one institution.
        J Arthroplasty. 2015; 30: 2275-2278https://doi.org/10.1016/J.ARTH.2015.06.058
        • Kunutsor S.K.
        • Whitehouse M.R.
        • Blom A.W.
        • Beswick A.D.
        Patient-related risk factors for periprosthetic joint infection after total joint arthroplasty: a systematic review and meta-analysis.
        PLoS One. 2016; 11: e0150866https://doi.org/10.1371/JOURNAL.PONE.0150866
        • Ashley B.S.
        • Parvizi J.
        Current insights in the evaluation and treatment of infected total knee arthroplasty.
        J Knee Surg. 2021; 34: 1388-1395https://doi.org/10.1055/S-0041-1737030
        • Xu C.
        • Goswami K.
        • Li W.T.
        • Tan T.L.
        • Yayac M.
        • Wang S.H.
        • et al.
        Is treatment of periprosthetic joint infection improving over time?.
        J Arthroplasty. 2020; 35: 1696-1702.e1https://doi.org/10.1016/J.ARTH.2020.01.080
        • Rethman M.P.
        • Watters W.
        • Abt E.
        • Anderson P.A.
        • Carroll K.C.
        • Evans R.P.
        • et al.
        The American Dental Association and the American Dental Association clinical practice guideline on the prevention of orthopaedic implant infection in patients undergoing dental procedures.
        J Bone Joint Surg Am. 2013; 95: 745-747https://doi.org/10.2106/00004623-201304170-00011
        • Alamanda V.K.
        • Springer B.D.
        Perioperative and modifiable risk factors for periprosthetic joint infections (PJI) and recommended guidelines.
        Curr Rev Musculoskelet Med. 2018; 11: 325-331https://doi.org/10.1007/S12178-018-9494-Z
        • Parvizi J.
        • Shohat N.
        • Gehrke T.
        Prevention of periprosthetic joint infection: new guidelines.
        Bone Joint J. 2017; 99-B: 3-10https://doi.org/10.1302/0301-620X.99B4.BJJ-2016-1212.R1
        • Norden C.W.
        Prevention of bone and joint infections.
        Am J Med. 1985; 78: 229-232https://doi.org/10.1016/0002-9343(85)90390-0
        • Keblish P.A.
        • Dickson T.B.
        • Vernick C.G.
        • Finnegan W.J.
        Hematogenous infection in total joint replacement: recommendations for prophylactic antibiotics.
        JAMA. 1979; 242: 2213-2214https://doi.org/10.1001/JAMA.1979.03300200043023
        • Ainscow D.A.P.
        • Denham R.A.
        The risk of haematogenous infection in total joint replacements.
        J Bone Joint Surg Br. 1984; 66: 580-582https://doi.org/10.1302/0301-620X.66B4.6430907
        • Jaspers M.T.
        • Little J.W.
        Prophylactic antibiotic coverage in patients with total arthroplasty: current practice.
        J Am Dent Assoc. 1985; 111: 943-948https://doi.org/10.14219/JADA.ARCHIVE.1985.0224
        • Quinn R.H.
        • Murray J.N.
        • Pezold R.
        • Sevarino K.S.
        The American academy of orthopaedic surgeons appropriate use criteria for the management of patients with orthopaedic implants undergoing dental procedures.
        J Bone Joint Surg Am. 2017; 99: 161-163https://doi.org/10.2106/JBJS.16.01107
        • Sollecito T.P.
        • Abt E.
        • Lockhart P.B.
        • Truelove E.
        • Paumier T.M.
        • Tracy S.L.
        • et al.
        The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints: evidence-based clinical practice guideline for dental practitioners--a report of the American Dental Association Council on Scientific Affairs.
        J Am Dent Assoc. 2015; 146: 11-16.e8https://doi.org/10.1016/J.ADAJ.2014.11.012
        • McNally C.M.
        • Visvanathan R.
        • Liberali S.
        • Adams R.J.
        Antibiotic prophylaxis for dental treatment after prosthetic joint replacement: exploring the orthopaedic surgeon’s opinion.
        Arthroplast Today. 2016; 2: 123-126https://doi.org/10.1016/J.ARTD.2015.12.003
        • Colterjohn T.
        • De Beer J.
        • Petruccelli D.
        • Zabtia N.
        • Winemaker M.
        Antibiotic prophylaxis for dental procedures at risk of causing bacteremia among post-total joint arthroplasty patients: a survey of Canadian orthopaedic surgeons and dental surgeons.
        J Arthroplasty. 2014; 29: 1091-1097https://doi.org/10.1016/J.ARTH.2013.11.024
        • Sonn K.A.
        • Larsen C.G.
        • Adams W.
        • Brown N.M.
        • McAsey C.J.
        Effect of preoperative dental extraction on postoperative complications after total joint arthroplasty.
        J Arthroplasty. 2019; 34: 2080-2084https://doi.org/10.1016/J.ARTH.2019.04.056
        • Skaar D.D.
        • O’Connor H.
        • Hodges J.S.
        • Michalowicz B.S.
        Dental procedures and subsequent prosthetic joint infections: findings from the Medicare current beneficiary survey.
        J Am Dent Assoc. 2011; 142: 1343-1351https://doi.org/10.14219/JADA.ARCHIVE.2011.0134
        • Berbari E.F.
        • Osmon D.R.
        • Carr A.
        • Hanssen A.D.
        • Baddour L.M.
        • Greene D.
        • et al.
        Dental procedures as risk factors for prosthetic hip or knee infection: a hospital-based prospective case-control study.
        Clin Infect Dis. 2010; 50: 8-16https://doi.org/10.1086/648676
        • Uçkay I.
        • Lübbeke A.
        • Emonet S.
        • Tovmirzaeva L.
        • Stern R.
        • Ferry T.
        • et al.
        Low incidence of haematogenous seeding to total hip and knee prostheses in patients with remote infections.
        J Infect. 2009; 59: 337-345https://doi.org/10.1016/J.JINF.2009.08.015
        • LaPorte D.M.
        • Waldman B.J.
        • Mont M.A.
        • Hungerford D.S.
        Infections associated with dental procedures in total hip arthroplasty.
        J Bone Joint Surg Br. 1999; 81: 56-59https://doi.org/10.1302/0301-620X.81B1.8608
        • Waldman B.J.
        • Mont M.A.
        • Hungerford D.S.
        Total knee arthroplasty infections associated with dental procedures.
        Clin Orthop Relat Res. 1997; 343: 164-172https://doi.org/10.1097/00003086-199710000-00027
        • Minassian C.
        • D’Aiuto F.
        • Hingorani A.D.
        • Smeeth L.
        Invasive dental treatment and risk for vascular events: a self-controlled case series.
        Ann Intern Med. 2010; 153: 499-506https://doi.org/10.7326/0003-4819-153-8-201010190-00006
        • Scannapieco F.A.
        • Bush R.B.
        • Paju S.
        Associations between periodontal disease and risk for atherosclerosis, cardiovascular disease, and stroke. A systematic review.
        Ann Periodontol. 2003; 8: 38-53https://doi.org/10.1902/ANNALS.2003.8.1.38
        • Tonetti M.S.
        • D’Aiuto F.
        • Nibali L.
        • Donald A.
        • Storry C.
        • Parker M.
        • et al.
        Treatment of periodontitis and endothelial function.
        N Engl J Med. 2007; 356: 911-920https://doi.org/10.1056/NEJMoa063186
        • Barrington J.W.
        • Barrington T.A.
        What is the true incidence of dental pathology in the total joint arthroplasty population?.
        J Arthroplasty. 2011; 26: 88-91https://doi.org/10.1016/J.ARTH.2011.03.036
        • Springer B.D.
        • Baddour L.M.
        • Lockhart P.B.
        • Thornhill M.H.
        Antibiotic prophylaxis for prosthetic joint patients undergoing invasive dental procedures: time for a rethink?.
        J Arthroplasty. 2022; 37: 1223-1226https://doi.org/10.1016/J.ARTH.2022.02.014
        • Thornhill M.H.
        • Crum A.
        • Rex S.
        • Stone T.
        • Campbell R.
        • Bradburn M.
        • et al.
        Analysis of prosthetic joint infections following invasive dental procedures in England.
        JAMA Netw Open. 2022; 5: e2142987https://doi.org/10.1001/JAMANETWORKOPEN.2021.42987
        • Kohler J.G.
        • Holte A.J.
        • Glass N.A.
        • Bedard N.A.
        • Brown T.S.
        Dental screening in elective total joint arthroplasty: risk factors for failure.
        J Arthroplasty. 2021; 36: 1548-1550https://doi.org/10.1016/J.ARTH.2020.12.026
        • Rosas S.
        • Sabeh K.G.
        • Buller L.T.
        • Law T.Y.
        • Roche M.W.
        • Hernandez V.H.
        Medical comorbidities impact the episode-of-care reimbursements of total hip arthroplasty.
        J Arthroplasty. 2017; 32: 2082-2087https://doi.org/10.1016/J.ARTH.2017.02.039
        • Sabeh K.G.
        • Rosas S.
        • Buller L.T.
        • Freiberg A.A.
        • Emory C.L.
        • Roche M.W.
        The impact of medical comorbidities on primary total knee arthroplasty reimbursements.
        J Knee Surg. 2019; 32: 475-482https://doi.org/10.1055/S-0038-1651529
        • Rosas S.
        • Sabeh K.G.
        • Buller L.T.
        • Law T.Y.
        • Kalandiak S.P.
        • Levy J.C.
        Comorbidity effects on shoulder arthroplasty costs analysis of a nationwide private payer insurance data set.
        J Shoulder Elbow Surg. 2017; 26: e216https://doi.org/10.1016/J.JSE.2016.11.044
        • Centers for Medicare & Medicaid Services
        Comprehensive care for joint replacement model (CJR).
        ([accessed 12.04.22])
        • Danilkowicz R.M.
        • Lachiewicz A.M.
        • Lorenzana D.J.
        • Barton K.D.
        • Lachiewicz P.F.
        Prosthetic joint infection after dental work: is the correct prophylaxis being prescribed? A systematic review.
        Arthroplast Today. 2021; 7: 69https://doi.org/10.1016/J.ARTD.2020.11.007
        • de Araújo Nobre M.
        • Maló P.
        Prevalence of periodontitis, dental caries, and peri-implant pathology and their relation with systemic status and smoking habits: results of an open-cohort study with 22009 patients in a private rehabilitation center.
        J Dent. 2017; 67: 36-42https://doi.org/10.1016/J.JDENT.2017.07.013
        • Elani H.W.
        • Starr J.R.
        • Da Silva J.D.
        • Gallucci G.O.
        Trends in dental implant use in the U.S., 1999-2016, and projections to 2026.
        J Dent Res. 2018; 97: 1424-1430https://doi.org/10.1177/0022034518792567
        • Terpenning M.
        Geriatric oral health and pneumonia risk.
        Clin Infect Dis. 2005; 40 (GIF): 1807-1810https://doi.org/10.1086/430603/3/40-12-1807-FIG001
        • De Oliveira C.
        • Watt R.
        • Hamer M.
        Toothbrushing, inflammation, and risk of cardiovascular disease: results from Scottish Health Survey.
        BMJ. 2010; 340: 1400https://doi.org/10.1136/BMJ.C2451
        • Joshipura K.J.
        • Hung H.C.
        • Rimm E.B.
        • Willett W.C.
        • Ascherio A.
        Periodontal disease, tooth loss, and incidence of ischemic stroke.
        Stroke. 2003; 34: 47-52https://doi.org/10.1161/01.STR.0000052974.79428.0C
        • Suzuki H.
        • Matsuo K.
        • Okamoto M.
        • Nakata H.
        • Sakamoto H.
        • Fujita M.
        Preoperative periodontal treatment and its effects on postoperative infection in cardiac valve surgery.
        Clin Exp Dent Res. 2019; 5: 485-490https://doi.org/10.1002/CRE2.212
        • Spreadborough P.
        • Lort S.
        • Pasquali S.
        • Popplewell M.
        • Owen A.
        • Kreis I.
        • et al.
        A systematic review and meta-analysis of perioperative oral decontamination in patients undergoing major elective surgery.
        Perioper Med. 2016; 5: 1-7https://doi.org/10.1186/S13741-016-0030-7
        • Inai Y.
        • Nomura Y.
        • Takarada T.
        • Hanada N.
        • Wada N.
        Risk factors for postoperative pneumonia according to examination findings before surgery under general anesthesia.
        Clin Oral Investig. 2020; 24: 3577-3585https://doi.org/10.1007/S00784-020-03230-7
        • Young H.
        • Hirsh J.
        • Hammerberg E.M.
        • Price C.S.
        Dental disease and periprosthetic joint infection.
        J Bone Joint Surg Am. 2014; 96: 162-168https://doi.org/10.2106/JBJS.L.01379
        • Pollard J.P.
        • Hughes S.P.F.
        • Evans M.J.
        • Scott J.E.
        • Benson M.K.D.
        Antibiotic prophylaxis in total hip replacement.
        Br Med J. 1979; 1: 707-709https://doi.org/10.1136/BMJ.1.6165.707
      1. Management of dental patients with prosthetic joints. Council on dental therapeutics.
        J Am Dent Assoc. 1990; 121: 537-538https://doi.org/10.14219/JADA.ARCHIVE.1990.0185
        • Nelson J Jr., R.F.
        • Jaspers M.
        • JBJS J.L.
        Prophylactic antimicrobial coverage in arthroplasty patients.
        J Bone Joint Surg Am. 1990; 72: 1
        • Shrout M.K.
        • Scarbrough F.
        • Powell B.J.
        Dental care and the prosthetic joint patient: a survey of orthopedic surgeons and general dentists.
        J Am Dent Assoc. 1994; 125: 429-430https://doi.org/10.14219/JADA.ARCHIVE.1994.0047
        • American Dental Association
        • American Academy of Orthopedic Surgeons
        Antibiotic prophylaxis for dental patients with total joint replacements.
        J Am Dent Assoc. 2003; 134: 895-898https://doi.org/10.14219/jada.archive.2003.0289
        • Watters W.
        • Rethman M.P.
        • Hanson N.B.
        • Abt E.
        • Anderson P.A.
        • Carroll K.C.
        • et al.
        Prevention of orthopaedic implant infection in patients undergoing dental procedures.
        J Am Acad Orthop Surg. 2013; 21: 180-189https://doi.org/10.5435/JAAOS-21-03-180
        • Pallasch T.J.
        • Slots J.
        Antibiotic prophylaxis and the medically compromised patient.
        Periodontol 2000. 1996; 10: 107-138https://doi.org/10.1111/J.1600-0757.1996.TB00071.X
        • Kurtz S.M.
        • Lau E.
        • Watson H.
        • Schmier J.K.
        • Parvizi J.
        Economic burden of periprosthetic joint infection in the United States.
        J Arthroplasty. 2012; 27: 61-65.e1https://doi.org/10.1016/J.ARTH.2012.02.022
        • Premkumar A.
        • Kolin D.A.
        • Farley K.X.
        • Wilson J.M.
        • McLawhorn A.S.
        • Cross M.B.
        • et al.
        Projected economic burden of periprosthetic joint infection of the hip and knee in the United States.
        J Arthroplasty. 2021; 36: 1484-1489.e3https://doi.org/10.1016/j.arth.2020.12.005
        • Yao J.J.
        • Hevesi M.
        • Visscher S.L.
        • Ransom J.E.
        • Lewallen D.G.
        • Berry D.J.
        • et al.
        Direct inpatient medical costs of operative treatment of periprosthetic hip and knee infections are twofold higher than those of aseptic revisions.
        J Bone Joint Surg Am. 2021; 103: 312-318https://doi.org/10.2106/JBJS.20.00550