Cargando…

Oral Health Screening for Risk Reduction for Early Periprosthetic Joint Infections of Hip and Knee Endoprostheses—Results of a Prospective Cohort Study

This prospective observational study had two aims: (I) to assess whether a preoperative dental screening before endoprosthesis (EP) implantation with need-based dental intervention would decrease the prevalence of periprosthetic joint infection (PJI) and (II) to evaluate whether instructed orthopedi...

Descripción completa

Detalles Bibliográficos
Autores principales: Fenske, Fabian, Krause, Leah, Meyer, Stephan, Kujat, Benjamin, Repmann, Jacqueline, Neuhaus, Michael, Zimmerer, Rüdiger, Roth, Andreas, Lethaus, Bernd, Ziebolz, Dirk, Schmalz, Gerhard
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10342984/
https://www.ncbi.nlm.nih.gov/pubmed/37445486
http://dx.doi.org/10.3390/jcm12134451
_version_ 1785072630044295168
author Fenske, Fabian
Krause, Leah
Meyer, Stephan
Kujat, Benjamin
Repmann, Jacqueline
Neuhaus, Michael
Zimmerer, Rüdiger
Roth, Andreas
Lethaus, Bernd
Ziebolz, Dirk
Schmalz, Gerhard
author_facet Fenske, Fabian
Krause, Leah
Meyer, Stephan
Kujat, Benjamin
Repmann, Jacqueline
Neuhaus, Michael
Zimmerer, Rüdiger
Roth, Andreas
Lethaus, Bernd
Ziebolz, Dirk
Schmalz, Gerhard
author_sort Fenske, Fabian
collection PubMed
description This prospective observational study had two aims: (I) to assess whether a preoperative dental screening before endoprosthesis (EP) implantation with need-based dental intervention would decrease the prevalence of periprosthetic joint infection (PJI) and (II) to evaluate whether instructed orthopedic surgeons would achieve similar results in oral screening as dentists. The preoperative oral health statuses of the patients, prior to EP insertion, were either evaluated by the patients’ general dentists (Ia) or, if the patient had not visited a general dentist, by an instructed orthopedic surgeon (Ib). Both the dentist and orthopedic surgeon used standardized risk estimation (low risk, moderate risk, and high risk) for an oral-health-related infectious complication after EP insertion, including a recommendation for further management of the patient. If required, a need-based dental rehabilitation was performed. In addition, retrospective data evaluation of a comparison group (II) was performed, which had not been screened orally preoperatively. A total of 777 patients (screening group (I): n = 402, of which 229 were screened by a dentist (Ia), 173 were screened by an orthopedic surgeon (Ib); comparison group (II): n = 375) were included. No general association between early infection rate and preoperative oral screening in general was found (1% PJI in screening group (I), 1.6% PJI in comparison group (II); p = 0.455). However, screening performance (dentist vs. orthopedic surgeon) had a significant impact on the prevalence of developed PJIs (p = 0.021). Thereby, 100% of observed infections in the screening group (I) occurred in the group with previous oral screening by an orthopedic surgeon (Ib). Furthermore, the C-reactive protein (CRP) value at discharge was significantly lower when general preoperative oral screening had been performed (group I vs. group II, p = 0.03). Only preoperative oral screening by a dentist had the potential to reduce oral-focus-associated EP infections; therefore, increased attention should be paid to the further promotion of interdisciplinary work between dentists and orthopedic surgeons. Dental screenings, using objectifiable criteria, as applied in this study, seem reasonable but require further validation in larger cohorts.
format Online
Article
Text
id pubmed-10342984
institution National Center for Biotechnology Information
language English
publishDate 2023
publisher MDPI
record_format MEDLINE/PubMed
spelling pubmed-103429842023-07-14 Oral Health Screening for Risk Reduction for Early Periprosthetic Joint Infections of Hip and Knee Endoprostheses—Results of a Prospective Cohort Study Fenske, Fabian Krause, Leah Meyer, Stephan Kujat, Benjamin Repmann, Jacqueline Neuhaus, Michael Zimmerer, Rüdiger Roth, Andreas Lethaus, Bernd Ziebolz, Dirk Schmalz, Gerhard J Clin Med Article This prospective observational study had two aims: (I) to assess whether a preoperative dental screening before endoprosthesis (EP) implantation with need-based dental intervention would decrease the prevalence of periprosthetic joint infection (PJI) and (II) to evaluate whether instructed orthopedic surgeons would achieve similar results in oral screening as dentists. The preoperative oral health statuses of the patients, prior to EP insertion, were either evaluated by the patients’ general dentists (Ia) or, if the patient had not visited a general dentist, by an instructed orthopedic surgeon (Ib). Both the dentist and orthopedic surgeon used standardized risk estimation (low risk, moderate risk, and high risk) for an oral-health-related infectious complication after EP insertion, including a recommendation for further management of the patient. If required, a need-based dental rehabilitation was performed. In addition, retrospective data evaluation of a comparison group (II) was performed, which had not been screened orally preoperatively. A total of 777 patients (screening group (I): n = 402, of which 229 were screened by a dentist (Ia), 173 were screened by an orthopedic surgeon (Ib); comparison group (II): n = 375) were included. No general association between early infection rate and preoperative oral screening in general was found (1% PJI in screening group (I), 1.6% PJI in comparison group (II); p = 0.455). However, screening performance (dentist vs. orthopedic surgeon) had a significant impact on the prevalence of developed PJIs (p = 0.021). Thereby, 100% of observed infections in the screening group (I) occurred in the group with previous oral screening by an orthopedic surgeon (Ib). Furthermore, the C-reactive protein (CRP) value at discharge was significantly lower when general preoperative oral screening had been performed (group I vs. group II, p = 0.03). Only preoperative oral screening by a dentist had the potential to reduce oral-focus-associated EP infections; therefore, increased attention should be paid to the further promotion of interdisciplinary work between dentists and orthopedic surgeons. Dental screenings, using objectifiable criteria, as applied in this study, seem reasonable but require further validation in larger cohorts. MDPI 2023-07-03 /pmc/articles/PMC10342984/ /pubmed/37445486 http://dx.doi.org/10.3390/jcm12134451 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Article
Fenske, Fabian
Krause, Leah
Meyer, Stephan
Kujat, Benjamin
Repmann, Jacqueline
Neuhaus, Michael
Zimmerer, Rüdiger
Roth, Andreas
Lethaus, Bernd
Ziebolz, Dirk
Schmalz, Gerhard
Oral Health Screening for Risk Reduction for Early Periprosthetic Joint Infections of Hip and Knee Endoprostheses—Results of a Prospective Cohort Study
title Oral Health Screening for Risk Reduction for Early Periprosthetic Joint Infections of Hip and Knee Endoprostheses—Results of a Prospective Cohort Study
title_full Oral Health Screening for Risk Reduction for Early Periprosthetic Joint Infections of Hip and Knee Endoprostheses—Results of a Prospective Cohort Study
title_fullStr Oral Health Screening for Risk Reduction for Early Periprosthetic Joint Infections of Hip and Knee Endoprostheses—Results of a Prospective Cohort Study
title_full_unstemmed Oral Health Screening for Risk Reduction for Early Periprosthetic Joint Infections of Hip and Knee Endoprostheses—Results of a Prospective Cohort Study
title_short Oral Health Screening for Risk Reduction for Early Periprosthetic Joint Infections of Hip and Knee Endoprostheses—Results of a Prospective Cohort Study
title_sort oral health screening for risk reduction for early periprosthetic joint infections of hip and knee endoprostheses—results of a prospective cohort study
topic Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10342984/
https://www.ncbi.nlm.nih.gov/pubmed/37445486
http://dx.doi.org/10.3390/jcm12134451
work_keys_str_mv AT fenskefabian oralhealthscreeningforriskreductionforearlyperiprostheticjointinfectionsofhipandkneeendoprosthesesresultsofaprospectivecohortstudy
AT krauseleah oralhealthscreeningforriskreductionforearlyperiprostheticjointinfectionsofhipandkneeendoprosthesesresultsofaprospectivecohortstudy
AT meyerstephan oralhealthscreeningforriskreductionforearlyperiprostheticjointinfectionsofhipandkneeendoprosthesesresultsofaprospectivecohortstudy
AT kujatbenjamin oralhealthscreeningforriskreductionforearlyperiprostheticjointinfectionsofhipandkneeendoprosthesesresultsofaprospectivecohortstudy
AT repmannjacqueline oralhealthscreeningforriskreductionforearlyperiprostheticjointinfectionsofhipandkneeendoprosthesesresultsofaprospectivecohortstudy
AT neuhausmichael oralhealthscreeningforriskreductionforearlyperiprostheticjointinfectionsofhipandkneeendoprosthesesresultsofaprospectivecohortstudy
AT zimmererrudiger oralhealthscreeningforriskreductionforearlyperiprostheticjointinfectionsofhipandkneeendoprosthesesresultsofaprospectivecohortstudy
AT rothandreas oralhealthscreeningforriskreductionforearlyperiprostheticjointinfectionsofhipandkneeendoprosthesesresultsofaprospectivecohortstudy
AT lethausbernd oralhealthscreeningforriskreductionforearlyperiprostheticjointinfectionsofhipandkneeendoprosthesesresultsofaprospectivecohortstudy
AT ziebolzdirk oralhealthscreeningforriskreductionforearlyperiprostheticjointinfectionsofhipandkneeendoprosthesesresultsofaprospectivecohortstudy
AT schmalzgerhard oralhealthscreeningforriskreductionforearlyperiprostheticjointinfectionsofhipandkneeendoprosthesesresultsofaprospectivecohortstudy