Relation between mouth and haematogenous infection in total joint replacements

To investigate the source of infections associated with orthopaedic prostheses.

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.

Four adults (three men) aged 58-83.

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.

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.