Safety of Total Joint Arthroplasty Following Treatment of Asymptomatic Dental Infections

Prevention of prosthetic joint infections (PJIs) in total joint arthroplasty (TJA) has received significant focus over the past decade. While overt systemic infections are typically screened preoperatively, the oral cavity can be a source of covert, asymptomatic infection, which may contribute to PJI risk. This study aimed to determine the incidence of oral infections in patients undergoing TJA.

A retrospective review was conducted on 648 consecutive patients who underwent primary total knee arthroplasty (TKA) or total hip arthroplasty (THA) between December 2022 and February 2024 at a single center. Inclusion criteria were patients 18 to 90 years old, who underwent primary TJA for osteoarthritis and received dental clearance from a board-certified dentist within 6 months preoperatively.

Of the patients evaluated, 4.9% (n = 32) had asymptomatic, active oral infections identified and treated prior to TJA. Treatment included tooth extraction with antibiotics (94%), crown replacement (3%), and root canal (3%). The average time to dental clearance prior to surgery was 8.1 days. No PJIs occurred in patients who had active oral infections treated preoperatively. Overall, there were four PJIs (0.6%) and two surgical site infections (0.3%), all among those with negative dental screenings. No significant differences were observed in hospital stay (p = 0.130), 90-day readmission (p = 1.00), or infection rates (p = 1.00) between the groups. Prior dental infection (18.8 vs. 3.6%, p < 0.001), history of tooth extraction (68.8 vs. 2.3%, p < 0.001), and hyperlipidemia (p = 0.04) were significantly associated with active oral infection.

Asymptomatic oral infections were found in 4.9% of patients undergoing TJA. The authors suggest a selective approach to dental evaluations based upon patient-specific risk factors. Active dental infections, appropriately managed in the preoperative period, should not preclude patients from timely TJA.

The level of evidence was III (retrospective cohort).