Markku Vuorinen

A multidisciplinary team responsible for the management plan of prosthetic joint infections (PJI) was founded in January 2008. The aim of this study was to investigate whether a decrease in the num...

Background and Aims: To prevent severe prosthetic joint infections, a dental examination is usually recommended prior to arthroplasty, even sometimes regarded resource- and time-consuming. The aim of this study was to determine whether a risk factor-based algorithm could be created to send only selected patients for dental clearance. Materials and Methods: A prospective study of 952 patients scheduled for elective arthroplasty was performed. Patients filled out a questionnaire regarding potential risk factors for dental infections, and dentists documented patients’ oral health and interventions performed (data available for 731 patients). Results: Of the patients, 215 (29.4%) failed dental clearance; a total of 432 teeth were extracted, 32 patients (4.4%) required root canal treatment, and 37 patients (5.1%) had severe periodontitis. Independent risk factors for failure were history of root canal treatment (odds ratio: 2.282, 95% confidence interval: 1.346–3.869, p = 0.020), use of tobacco products (odds ratio: 1.704, 95% confidence interval: 1.033–2.810, p = 0.037), dental visit indicated by oral symptoms within 3 months (odds ratio: 1.828, 95% confidence interval: 1.183–2.827, p = 0.007), or visit to a dentist within 6 months (odds ratio: 1.538, 95% confidence interval: 1.063–2.224, p = 0.022). Regular dental examination was a preventive factor (odds ratio: 0.519, 95% confidence interval: 0.349–0.773, p = 0.001). However, based on the examined risk factors, no sufficiently large group of patients at lesser risk for dental infections could be identified. Conclusion: Because of the high need for dental care revealed by our unselected patient population, the inspection and treatment of dental pathology of all patients are important interventions prior to elective arthroplasty.

Dexamethasone has been shown to prevent post-operative nausea and vomiting (PONV) and seems to reduce post-operative pain. Both factors, which can extend the hospital stay, delay rehabilitation, and impact patient satisfaction. Because of the immunosuppressive and glucose-rising effects of dexamethasone, there has been concern of its safety in arthroplasty surgery. The purpose of our study was to examine infection safety of dexamethasone in arthroplasty surgery with enough large study material to reliably detect a possible, even small, difference in infection incidence.