Abstract
Background. Just under 2% of the joint infection work performed over the last 10 years in our institution has involved organisms found in the oropharynx. The issue of antibiotic prophylaxis for dental work in the presence of a joint prosthesis is controversial. However, advanced dental sepsis requires detection and treatment prior to joint replacement.
Methods. Patients from whom non B-haemolytic streptococcal were recovered from revisions of prosthetic joints over the period 1993–2003 were retrospectively reviewed for predisposing factors.
Results. 9 patients had viridans streptococcal infection detected and confirmed by histology and culture at excision arthroplasty. There were 5 total hip joints, 3 knee arthroplasties and 1 shoulder affected. No patient had a history of endocarditis. Two of the patients had previously had multiple revisions. Mean interval in these patients since last surgery was 7.6 years. All patients underwent 2 stage revision procedures. All patients required multiple dental extractions in the interval between 1st and 2nd stage surgery.
On reviewing the patients’ histories further: One patient had reported a broken tooth reported at the time of surgery and been given reassurancethat it was safe to proceed. One patient had an overt dental abscess ongoing for 15 years and one patient had an occult dental abscess revealed on radiology. Two other patients had extensive dental caries with blackened stumps as teeth. Follow-up after antibiotic treatment and revision arthroplasty is limited in these cases but results appear satisfactory at up to five years.
Conclusion. Poor dental care is associated with an increased risk of arthroplasty infection. Looking in the mouth should be a routine part of pre-op assessment prior to primary joint replacement, just as it would be in a cardiac surgery unit. Patients referred from other centres for revision arthroplasty should receive a dental examination if excision arthroplasty cultures yield viridans streptococci.
The abstracts were prepared by Mr Peter Kay, Editorial Secretary. Correspondence should be addressed to British Hip Society, The Hip Centre, Wrightington Hospital, Appley Bridge, Wigan, Lancashire WN6 9EP.
