Dental Procedures Not Linked to Increased Risk of Joint Infections after Knee Arthroplasty

SOUTH KOREA: A nationwide, population-based retrospective cohort study has found that dental procedures do not elevate the risk of periprosthetic joint infections (PJI) in patients who have undergone primary and revision total knee arthroplasty (TKA). The study’s findings offer reassurance to patients and clinicians alike regarding the safety of dental procedures following knee arthroplasty.

Prophylactic Antibiotics: Limited Efficacy

Reassessment Needed: Antibiotic Prophylaxis in Dental Procedures Post Total Joint Arthroplasty

Contrary to conventional practice, the study revealed that prophylactic antibiotics administered before dental procedures did not reduce the risk of PJI in patients with knee arthroplasty. This finding challenges existing beliefs and prompts reconsideration of antibiotic prophylaxis protocols in this patient population. Additionally, the study highlighted that posttraumatic arthritis, rather than dental procedures or antibiotic use, was significantly associated with PJI risk.

Conducted in South Korea using data spanning a decade, the retrospective study enrolled over 591,000 patients who had undergone unilateral primary or revision TKA. Among them, 61,446 patients had undergone dental procedures post-TKA. Propensity score matching was employed to compare cohorts and control for variables influencing PJI risk. 

Results showed that dental procedures did not increase the risk of PJI following primary or revision TKA, with adjusted hazard ratios indicating no significant association.

Implications for Clinical Practice

The study’s findings carry significant implications for clinical practice, particularly in orthopedic surgery and dentistry. Surgeons and dentists may reconsider the necessity of prophylactic antibiotics before dental procedures in patients with knee arthroplasty, given the lack of demonstrated efficacy in preventing PJI. Instead, emphasis may shift towards managing other risk factors, such as posttraumatic arthritis, to mitigate the risk of joint infections.

Reevaluation of Practice Guidelines

This nationwide study provides robust evidence challenging the traditional notion of increased PJI risk following dental procedures in patients with knee arthroplasty. 

It underscores the importance of reevaluating practice guidelines and adopting evidence-based approaches to optimize patient care and safety in orthopedic and dental settings.