Is it important to screen a patient for dental caries, ear infections, skin and urinary infections prior to an elective arthroplasty? If essential, what action must be taken if one detects a dental caries or a chronic ear infection which is not likely to have a short term solution?
absolutely vital. even any elective orthopaedic procedure require so. we are working SNP related with higher susceptibility of individuals for surgical post op infections
The schedule of elective surgery should be set after curing any existing infection elsewhere. I think it is a very important issue for avoiding postoperative disappointments. Unfortunately, it is not always done.
Dear Murali
Arthroplasty, in most cases is an elective surgical procedure and there is no justification the screening for infective foci not be done in a complete preoperative exams
THERE ARE TWO NEW PAPERS WHICH ARE WORTH DISCUSSING IN THIS CONTEXT. HERE THEY ARE
Total Joint Arthroplasty: Should Patients Have Preoperative Dental Clearance?
Alexander Lampley, MD, Ronald C. Huang, MD, William V. Arnold, MD, PhD, Javad Parvizi, MD, FRCS
Received 20 May 2013; accepted 24 November 2013. published online 04 December 2013.
The Journal of Arthroplasty
Volume 29, Issue 6 , Pages 1091-1097, June 2014
Abstract
Obtaining dental clearance prior to elective total joint arthroplasty is a common practice; however, little published data exist to justify this requirement. Dental clearance data for 365 elective total knee and total hip arthroplasty patients were gathered prospectively. Of these patients, 358 (average age of 62.4years; 157 men and 201 women; 152 primary total knee arthroplasties (TKAs), 16 revision TKA arthroplasties, one conversion TKA, 168 primary total hip (THAs) arthroplasties and 21 revision THA arthroplasties) proceeded to surgery and follow-up data were available for 355. A comparison group of 218 hip fracture patients (average age of 78.7years; 52 men and 109 women; 137 THA and 81 hemiarthroplasties) with no preoperative dental clearance who were treated with hip arthroplasty was extracted retrospectively from an institutional database. Follow-up data were available for 161 of these patients. The incidence of dental pathology in the elective arthroplasty group was 8.8%. Early postoperative infection requiring surgical treatment occurred in six patients (1.7%) in the dental clearance elective arthroplasty group and in four patients (2.5%) in the hip fracture arthroplasty group. No statistical difference was found between the two groups. This suggests that the perceived need for routine preoperative dental screening for all hip and knee arthroplasty patients should be reassessed.
2. Antibiotic Prophylaxis for Dental Procedures at Risk of Causing Bacteremia Among Post-Total Joint Arthroplasty Patients: A Survey of Canadian Orthopaedic Surgeons and Dental Surgeons
Tristan Colterjohn, BAS, Justin de Beer, MD, FRCSC, Danielle Petruccelli, MLIS, MSc, Nazar Zabtia, MD, FRCSC, Mitch Winemaker, MD, FRCSC
Abstract
To elicit current practice and attitudes toward use of antibiotic-prophylaxis among TJA patients prior to dental procedures, a cross-sectional survey of practicing Canadian orthopaedic (OS) and dental surgeons (DS) was undertaken. Of respondents, 77% of OS and 71% of DS routinely prescribe antibiotic-prophylaxis, but while 63% of OS advocate lifelong use, only 22% of DS choose to do so (P
Thank you, Dr. Poduval for the interesting references. Nevertheless, dental foci should be cured preoperatively. A common sense consideration is the probability of an activation of a dental infection in the postooperative period which sometimes happens with latent infective foci. Furthermore, I think urinary infections are the frequent origin for infections after arrhroplasty connected to the abuse of urethral catheters in the postoperative period.
According to our senior surgeon experience , we establish a protocol before elective arthroplasties about preoperative infection focus investigation. we called patient three week / one month before and take dental counsultation , infectious disease counsultation /cardiology and internal medicine counsultation in a routinely manner.İfany focus we detected we treat them before surgery .
According to our senior surgeon 24 years experience, we have not experienced any post operative infection after arthroplasties.
Also for female patients we routinely take ginecology counsultation and urine analysis to eliminate urinary system and ginecologic infections which frequently elderly female patients suffered.
Dr. Kemal, this is a very reliable protocol. The absence of postoperative infections after arthroplasty in your experience is very impressing. Did you publish your results related to postoperative infections so far ? Do you use perioperative antibiotic prophylaxis ? What antibiotic do you apply and in what dosage ?
Thanks dr tanchev , we could not publish results ,regarding to perioperative prophylaxis we use single dose sephasoline 1gr /IV ... in routine manner.
If operation time exceeds 4 hours than we added one dose more .For some special circumstances we use metranidazole +sephazoline combination.(for long period revision surgeries ). According to us the main philosophy must be perfect preperation before the surgery ,and no doubt in mind about the infection focci.
Thanks for all contributors.
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