UTCAT2066, Found CAT view, CRITICALLY APPRAISED TOPICs

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Title

Dental Procedures Do Not Raise The Risk Of Infection Of Prosthetic Hip Or Knee Joints

Clinical Question

In a patient who has had prosthetic replacement of the hip or knee joint, does dental treatment increase the likelihood of prosthesis infection? Does antibiotic prophylaxis at dental treatment lower the likelihood of prosthesis infection?

Clinical Bottom Line

Dental procedures do not raise the risk of infection of prosthetic hip or knee joints, nor does antibiotic prophylaxis for dental procedures lower the likelihood of joint infection.

Best Evidence

(you may view more info by clicking on the PubMed ID link)

PubMed ID	Author / Year	Patient Group	Study type (level of evidence)
#1) 19951109	Berbari / 2010	339 cases, 339 controls, all underwent prosthetic hip or knee replacement	Case-Control
Key results	Patients who had dental procedures without antibiotic prophylaxis were no more likely to experience joint infection than patients who did not have dental procedures. The adjusted odds ratio (OR) for prosthetic hip or knee infection was 0.8 (95% CI 0.4-1.6) in patients who underwent high-risk or low-risk dental procedure but were not administered antibiotic prophylaxis, and 0.6 (0.4-1.1) in patients who did not undergo a dental procedure. Furthermore, antibiotic prophylaxis for dental procedures did not lower the likelihood of later joint infection. OR with prophylaxis 0.9 (0.5-1.6), OR without prophylaxis 1.2 (0.7-2.2) 10.3% of the prosthetic joint infections were caused by microorganisms of potential oral or dental origin.
#2) 18591588	Uckay / 2008	Humans	Systematic Review of weak evidence
Key results	Of 144 articles meeting relevance criteria, 24 were case reports (7 reporting at least 3 cases), 23 prospectively studied post-dental-procedure bacteremia, and 35 were reviews. Twenty-seven of these articles favored pre-dental-treatment antibiotic prophylaxis, 11 reported no benefit, and the remaining 106 stated no clear position.

Evidence Search

"Case-Control Studies"[Mesh] AND "Dentistry"[Mesh] AND ("Prosthesis-Related Infections"[Mesh] OR "Arthroplasty, Replacement, Knee"[Mesh] OR "Arthroplasty, Replacement, Hip"[Mesh]) NOT "Cementation"[Mesh]

Comments on
The Evidence

The Berbari study included 339 cases with prosthetic hip or knee infections and 339 controls without such infection; all were recruited from a single tertiary-care hospital in Minnesota. Sampling and measurement bias were minimized by capturing the dental chart information before the prosthetic joint infection occurred, and the dental record reviewer was blinded to subject’s case/controls status. Eighty-six percent of cases and 92% of controls were dentate. 57% of dentate cases and 47% of dentate controls had a high-risk dental procedure within the 2 year observation period. Personal oral hygiene practices and professional oral hygiene visits were comparable between groups. Periodontal pockets were not analyzed.
The Uckay article is cited because, although it summarized weak evidence, it was the only systematic review on this question that we could identify. The Berbari article should therefore take precedence.
Prosthetic joint infection is an uncommon event, occurring in about 1% of primary arthroplasties. A randomized controlled trial on this question would require an impracticable number of subjects. Therefore the case-control study is the strongest evidence that we have on such a question.

Applicability

Subjects were from the midwestern USA between 2001 and 2006. Median age was 69.5 years (range 25.7-91.2) for cases and 71.4 years (36.0-94.8) for controls. "Case patients were patients hospitalized with total hip or knee infection. Control subjects were patients who underwent a total hip or knee arthroplasty but without a prosthetic joint infection who were hospitalized during the same period on the same orthopedic floor."

Specialty/Discipline

(Oral Medicine/Pathology/Radiology) (General Dentistry) (Oral Surgery) (Periodontics)

Keywords

antibiotic prophylaxis, prosthetic joint replacement

ID#

2066

Date of submission:

07/07/2011

E-mail

curtisjg@livemail.uthscsa.edu

Author

Joseph Curtis

Co-author(s)

Co-author(s) e-mail

Faculty mentor/Co-author

S. Thomas Deahl, II, DMD, PhD

Faculty mentor/Co-author e-mail

DEAHL@uthscsa.edu

Basic Science Rationale (Mechanisms that may account for and/or explain the clinical question, i.e. is the answer to the clinical question consistent with basic biological, physical and/or behavioral science principles, laws and research?)	post a rationale
None available

Comments and Evidence-Based Updates on the CAT
(FOR PRACTICING DENTISTS', FACULTY, RESIDENTS and/or STUDENTS COMMENTS ON PUBLISHED CATs)

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