BMJ 1994;309:506-508 (20 August)

Papers

Relation between mouth and haematogenous infection in total joint replacements

C A Bartzokas, R Johnson, M Jane, M V Martin, P K Pearce, Y Saw 

Wirral Hospital NHS Trust, Wirral, Merseyside L49 5PE Liverpool Dental Hospital, Liverpool L3 5PS Correspondence to: Dr C A Bartzokas, Department of Medical Microbiology, Wirral Hospital NHS Trust, Clatterbridge Hospital, Bebington, Wirral L63 4JY.

Abstract

Objective : To investigate the source of infections associated with orthopaedic prostheses.
Design : Analysis of four infections of prosthetic joints with case records; minimum inhibitory and minimum bactericidal concentrations and sodium dodecylsulphate polyacrylamide gel electrophoresis of the cell wall polypeptides of the Streptococcus sanguis isolates from the mouth and infected prostheses; examination of the patients' mouths for periodontal disease and caries.
Subjects : Four adults (three men) aged 58-83.
Results : For each patient the strain of S sanguis isolated from the mouth was indistinguishable from that isolated from the prosthesis. All patients had severe periodontal disease and caries.
Conclusions : The mouth was probably the source of bacterial infection in the prosthetic joints of these patients; the route of infection was possibly haematogenous. Incipient oral infection should be treated before joint replacement, and oral health should be maintained indefinitely.

Clinical implications

  • Clinical implications

  • The source of secondary infection of prosthetic joints has been attributed to the mouth

  • No definitive evidence for this association, however, has been reported

  • This study confirms that oral sepsis can be a source of bloodborne infection of prosthetic joints

  • Incipient oral sepsis should be treated before a patient has a joint replacement, and oral health should be maintained indefinitely


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Relevant Article

Oral infection and surgery
G Stansby, M Byrne, and G Hamilton
BMJ 1994 309: 880. [Extract] [Full Text]

This article has been cited by other articles:

  • Uckay, I., Pittet, D., Bernard, L., Lew, D., Perrier, A., Peter, R. (2008). Antibiotic prophylaxis before invasive dental procedures in patients with arthroplasties of the hip and knee. J Bone Joint Surg Br 90-B: 833-838 [Abstract] [Full text]  
  • Lockhart, P. B., Loven, B., Brennan, M. T., Fox, P. C. (2007). The evidence base for the efficacy of antibiotic prophylaxis in dental practice. Journal of the American Dental Association 138: 458-474 [Abstract] [Full text]  
  • AMERICAN DENTAL ASSOCIATION, , AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS, (2003). Antibiotic prophylaxis for dental patients with total joint replacements. Journal of the American Dental Association 134: 895-898 [Abstract] [Full text]  
  • SMITH, A.J., JACKSON, M.S., BAGG, J. (2001). The ecology of Staphylococcus species in the oral cavity. J Med Microbiol 50: 940-946 [Abstract] [Full text]  
  • Stansby, G, Byrne, M, Hamilton, G (1994). Oral infection and surgery. BMJ 309: 880d-880 [Full text]  
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