Skip to main content

Advertisement

SpringerLink
Log in

The influence of prior dental pathology on medical complications and peri-prosthetic joint infections following primary shoulder arthroplasty

  • Original Article
  • Published:
European Journal of Orthopaedic Surgery & Traumatology Aims and scope Submit manuscript

Abstract

Purpose

Antibiotic prophylaxis before invasive dental procedures is a common practice in the USA. Consensus regarding the influence of prior dental pathology (DP) on postoperative complications is lacking. The objectives are to determine the association of DP prior to shoulder arthroplasty (SA) on: (1) lengths of stay (LOS), (2) medical complications, (3) readmissions, (4) implant-related complications including peri-prosthetic joint infections (PJIs) and (5) healthcare expenditures.

Methods

The PearlDiver database was queried for primary shoulder arthroplasty from 2010 to 2020. Patients with history of dental caries or dental implant placement before SA represented the study group (n = 1419). Patients without prior DP represented controls (n = 7062). Study group patients were 1:5 ratio matched to controls by age, sex, and comorbidities. Outcomes included LOS, 90-day complications, readmissions, 2-year implant-related complications, and healthcare reimbursements. Logistic regression was used to calculate odds ratios (OR) of complications and readmissions. T tests compared LOS and costs. P values < 0.003 were significant.

Results

LOS (2.17 vs. 2.07 days; p = 0.071) were similar between groups. Patients with DP had higher 90-day medical complications compared to controls (OR: 1.74, p < 0.0001), including myocardial infarctions (2.2% vs. 0.8%; OR: 2.79, p < 0.0001), acute kidney injuries (8.3% vs. 4.6%; OR: 1.92, p < 0.0001), and pneumonias (8.7% vs. 5.3%; OR: 1.72, p < 0.0001). Readmission rates (1.97% vs. 1.54%; p = 0.248) were similar. Two-year implant complications were higher in patients with DP compared to controls (16.1% vs. 11.5%; OR: 1.38, p = 0.0003), including dislocations (6.4% vs. 4.5%; OR: 1.45, p = 0.002) and mechanical loosenings (4.0% vs. 2.4%; OR: 1.67, p = 0.001); however, PJIs were similar (2.2% vs. 1.9%; OR: 1.12, p = 0.583). Healthcare expenditures between groups were similar ($12,611 vs. $12,059; p = 0.075).

Conclusion

Patients with prior DP have higher 90-day medical complications and 2-year implant-related complications. Two-year incidence of PJIs were similar between groups. These findings can help shoulder surgeons counsel patients with a pertinent dental history.

Level of evidence III. Retrospective comparative study.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Wagner ER, Farley KX, Higgins I et al (2020) The incidence of shoulder arthroplasty: rise and future projections compared with hip and knee arthroplasty. J shoulder Elb Surg 29:2601–2609. https://doi.org/10.1016/J.JSE.2020.03.049

    Article  Google Scholar 

  2. Kim SH, Wise BL, Zhang Y, Szabo RM (2011) Increasing incidence of shoulder arthroplasty in the United States. J Bone Jt Surg Ser A 93:2249–2254. https://doi.org/10.2106/JBJS.J.01994

    Article  Google Scholar 

  3. Day JS, Lau E, Ong KL et al (2010) Prevalence and projections of total shoulder and elbow arthroplasty in the United States to 2015. J Shoulder Elb Surg 19:1115–1120. https://doi.org/10.1016/j.jse.2010.02.009

    Article  Google Scholar 

  4. Ortmaier R, Resch H, Hitzl W et al (2014) Treatment strategies for infection after reverse shoulder arthroplasty. Eur J Orthop Surg Traumatol 24:723–731. https://doi.org/10.1007/S00590-013-1251-9

    Article  PubMed  Google Scholar 

  5. Kunutsor SK, Whitehouse MR, Blom AW, Beswick AD (2016) Patient-related risk factors for periprosthetic joint infection after total joint arthroplasty: a systematic review and meta-analysis. PLoS ONE. https://doi.org/10.1371/JOURNAL.PONE.0150866

    Article  PubMed  PubMed Central  Google Scholar 

  6. Garrigues GE, Zmistowski B, Cooper AM et al (2019) Proceedings from the 2018 international consensus meeting on orthopedic infections: the definition of periprosthetic shoulder infection. J Shoulder Elb Surg 28:S8–S12. https://doi.org/10.1016/J.JSE.2019.04.034

    Article  Google Scholar 

  7. Cooper ME, Trivedi NN, Sivasundaram L et al (2019) Diagnosis and management of periprosthetic joint infection after shoulder arthroplasty. JBJS Rev. https://doi.org/10.2106/JBJS.RVW.18.00152

    Article  PubMed  Google Scholar 

  8. Farley KX, Wilson JM, Kumar A et al (2021) Prevalence of shoulder arthroplasty in the United States and the increasing burden of revision shoulder arthroplasty. JBJS Open Access. https://doi.org/10.2106/JBJS.OA.20.00156

    Article  PubMed  PubMed Central  Google Scholar 

  9. Simha S, Shields EJW, Wiater JM (2018) Periprosthetic infections of the shoulder. JBJS Rev 6:e6. https://doi.org/10.2106/JBJS.RVW.17.00191

    Article  PubMed  Google Scholar 

  10. Paxton ES, Green A, Krueger VS (2019) Periprosthetic infections of the shoulder: diagnosis and management. J Am Acad Orthop Surg 27:E935–E944. https://doi.org/10.5435/JAAOS-D-18-00232

    Article  PubMed  Google Scholar 

  11. Aibinder W, Schoch B, Parsons M et al (2021) Risk factors for complications and revision surgery after anatomic and reverse total shoulder arthroplasty. J Shoulder Elb Surg. https://doi.org/10.1016/j.jse.2021.04.029

    Article  Google Scholar 

  12. Rethman MP, Watters W, Abt E et al (2013) The American Academy of Orthopaedic Surgeons and the American Dental Association clinical practice guideline on the prevention of orthopaedic implant infection in patients undergoing dental procedures. J Bone Joint Surg Am 95:745–747. https://doi.org/10.2106/00004623-201304170-00011

    Article  PubMed  Google Scholar 

  13. Alamanda VK, Springer BD (2018) Perioperative and modifiable risk factors for periprosthetic joint infections (PJI) and recommended guidelines. Curr Rev Musculoskelet Med 11:325–331. https://doi.org/10.1007/S12178-018-9494-Z

    Article  PubMed  PubMed Central  Google Scholar 

  14. Richards J, Inacio MCS, Beckett M et al (2014) Patient and procedure-specific risk factors for deep infection after primary shoulder arthroplasty. Clin Orthop Relat Res 472:2809–2815. https://doi.org/10.1007/s11999-014-3696-5

    Article  PubMed  PubMed Central  Google Scholar 

  15. Keblish PA, Dickson TB, Vernick CG, Finnegan WJ (1979) Hematogenous infection in total joint replacement: recommendations for prophylactic antibiotics. JAMA 242:2213–2214. https://doi.org/10.1001/JAMA.1979.03300200043023

    Article  PubMed  Google Scholar 

  16. Ainscow DAP, Denham RA (1984) The risk of haematogenous infection in total joint replacements. J Bone Joint Surg Br 66:580–582. https://doi.org/10.1302/0301-620X.66B4.6430907

    Article  CAS  PubMed  Google Scholar 

  17. Jaspers MT, Little JW (1985) Prophylactic antibiotic coverage in patients with total arthroplasty: current practice. J Am Dent Assoc 111:943–948. https://doi.org/10.14219/JADA.ARCHIVE.1985.0224

    Article  CAS  PubMed  Google Scholar 

  18. Quinn RH, Murray JN, Pezold R, Sevarino KS (2017) The American Academy of Orthopaedic Surgeons appropriate use criteria for the management of patients with orthopaedic implants undergoing dental procedures. J Bone Joint Surg Am 99:161–163. https://doi.org/10.2106/JBJS.16.01107

    Article  PubMed  Google Scholar 

  19. Sollecito TP, Abt E, Lockhart PB et al (2015) The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints: evidence-based clinical practice guideline for dental practitioners–a report of the American Dental Association Council on Scientific Affairs. J Am Dent Assoc 146:11-16.e8. https://doi.org/10.1016/J.ADAJ.2014.11.012

    Article  PubMed  Google Scholar 

  20. McNally CM, Visvanathan R, Liberali S, Adams RJ (2016) Antibiotic prophylaxis for dental treatment after prosthetic joint replacement: exploring the orthopaedic surgeon’s opinion. Arthroplast today 2:123–126. https://doi.org/10.1016/J.ARTD.2015.12.003

    Article  PubMed  PubMed Central  Google Scholar 

  21. Sonn KA, Larsen CG, Adams W et al (2019) Effect of preoperative dental extraction on postoperative complications after total joint arthroplasty. J Arthroplasty 34:2080–2084. https://doi.org/10.1016/J.ARTH.2019.04.056

    Article  PubMed  Google Scholar 

  22. Skaar DD, O’Connor H, Hodges JS, Michalowicz BS (2011) Dental procedures and subsequent prosthetic joint infections: findings from the Medicare Current Beneficiary Survey. J Am Dent Assoc 142:1343–1351. https://doi.org/10.14219/JADA.ARCHIVE.2011.0134

    Article  PubMed  Google Scholar 

  23. Barrington JW, Barrington TA (2011) What is the true incidence of dental pathology in the total joint arthroplasty population? J Arthroplasty 26:88–91. https://doi.org/10.1016/J.ARTH.2011.03.036

    Article  PubMed  Google Scholar 

  24. Thornhill MH, Crum A, Rex S et al (2022) Analysis of prosthetic joint infections following invasive dental procedures in England. JAMA Netw Open. https://doi.org/10.1001/JAMANETWORKOPEN.2021.42987

    Article  PubMed  PubMed Central  Google Scholar 

  25. Springer BD, Baddour LM, Lockhart PB, Thornhill MH (2022) Antibiotic prophylaxis for prosthetic joint patients undergoing invasive dental procedures: Time for a rethink? J Arthroplasty. https://doi.org/10.1016/J.ARTH.2022.02.014

    Article  PubMed  Google Scholar 

  26. Minassian C, D’Aiuto F, Hingorani AD, Smeeth L (2010) Invasive dental treatment and risk for vascular events: a self-controlled case series. Ann Intern Med 153:499–506. https://doi.org/10.7326/0003-4819-153-8-201010190-00006

    Article  PubMed  Google Scholar 

  27. Scannapieco FA, Bush RB, Paju S (2003) Associations between periodontal disease and risk for atherosclerosis, cardiovascular disease, and stroke. A systematic review. Ann Periodontol 8:38–53. https://doi.org/10.1902/ANNALS.2003.8.1.38

    Article  PubMed  Google Scholar 

  28. Tonetti MS, D’Aiuto F, Nibali L et al (2007) Treatment of periodontitis and endothelial function. N Engl J Med 356:911–920. https://doi.org/10.1056/NEJMoa063186

    Article  CAS  PubMed  Google Scholar 

  29. Gordon AM, Diamond KB, Ashraf AM et al (2022) Benign prostatic hyperplasia is associated with increased 90-day medical complications but not peri-prosthetic joint infections following reverse shoulder arthroplasty. Eur J Orthop Surg Traumatol. https://doi.org/10.1007/S00590-022-03344-6

    Article  PubMed  PubMed Central  Google Scholar 

  30. Schoch BS, King JJ, Wright TW et al (2022) Patient age at time of reverse shoulder arthroplasty remains stable over time: a 7.5-year trend evaluation. Eur J Orthop Surg Traumatol. https://doi.org/10.1007/S00590-022-03227-W

    Article  PubMed  Google Scholar 

  31. Danilkowicz RM, Lachiewicz AM, Lorenzana DJ et al (2021) Prosthetic joint infection after dental work: Is the correct prophylaxis being prescribed? A systematic review. Arthroplast Today 7:69. https://doi.org/10.1016/J.ARTD.2020.11.007

    Article  PubMed  PubMed Central  Google Scholar 

  32. Terpenning M (2005) Geriatric oral health and pneumonia risk. Clin Infect Dis 40:1807–1810. https://doi.org/10.1086/430603/3/40-12-1807-FIG001.GIF

    Article  PubMed  Google Scholar 

  33. Young H, Hirsh J, Hammerberg EM, Price CS (2014) Dental disease and periprosthetic joint infection. J Bone Joint Surg Am 96:162–168. https://doi.org/10.2106/JBJS.L.01379

    Article  PubMed  Google Scholar 

  34. Pollard JP, Hughes SPF, Evans MJ et al (1979) Antibiotic prophylaxis in total hip replacement. Br Med J 1:707–709. https://doi.org/10.1136/BMJ.1.6165.707

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  35. Council on Dental Therapeutics (1990) Management of dental patients with prosthetic joints. J Am Dent Assoc 121:537–538. https://doi.org/10.14219/JADA.ARCHIVE.1990.0185

    Article  Google Scholar 

  36. Nelson J, Jr RF, Jaspers M, et al Prophylactic antimicrobial coverage in arthroplasty patients. journals.lww.com

  37. Shrout MK, Scarbrough F, Powell BJ (1994) Dental care and the prosthetic joint patient: a survey of orthopedic surgeons and general dentists. J Am Dent Assoc 125:429–430. https://doi.org/10.14219/JADA.ARCHIVE.1994.0047

    Article  CAS  PubMed  Google Scholar 

  38. American Dental Association, American Academy of Orthopedic Surgeons (2003) Antibiotic prophylaxis for dental patients with total joint replacements. J Am Dent Assoc 134:895–898. https://doi.org/10.14219/jada.archive.2003.0289

    Article  Google Scholar 

  39. Watters W, Rethman MP, Hanson NB et al (2013) Prevention of orthopaedic implant infection in patients undergoing dental procedures. J Am Acad Orthop Surg 21:180–189. https://doi.org/10.5435/JAAOS-21-03-180

    Article  PubMed  Google Scholar 

  40. Pallasch TJ, Slots J (1996) Antibiotic prophylaxis and the medically compromised patient. Periodontology 10:107–138. https://doi.org/10.1111/J.1600-0757.1996.TB00071.X

    Article  CAS  Google Scholar 

  41. Berbari EF, Osmon DR, Carr A et al (2010) Dental procedures as risk factors for prosthetic hip or knee infection: a hospital-based prospective case-control study. Clin Infect Dis 50:8–16. https://doi.org/10.1086/648676

    Article  PubMed  Google Scholar 

  42. Padegimas EM, Maltenfort M, Ramsey ML et al (2015) Periprosthetic shoulder infection in the United States: incidence and economic burden. J Shoulder Elb Surg 24:741–746. https://doi.org/10.1016/j.jse.2014.11.044

    Article  Google Scholar 

  43. Baghdadi YMK, Maradit-Kremers H, Dennison T et al (2017) The hospital cost of two-stage reimplantation for deep infection after shoulder arthroplasty. JSES Open Access 1:15. https://doi.org/10.1016/J.JSES.2017.02.001

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Acknowledgements

None.

Funding

No funding was received for conducting this study.

Author information

Authors and Affiliations

  1. Department of Orthopaedic Surgery and Rehabilitation, Maimonides Medical Center, 927 49th Street, Brooklyn, NY, 11219, USA

    Adam M. Gordon, Andrew R. Horn, Keith B. Diamond, Eric S. Roth, Miriam D. Weisberg, Ramin Sadeghpour & Jack Choueka

Authors
  1. Adam M. Gordon
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Andrew R. Horn
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Keith B. Diamond
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Eric S. Roth
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Miriam D. Weisberg
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ramin Sadeghpour
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Jack Choueka
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Adam M. Gordon.

Ethics declarations

Conflict of interest

The authors have no relevant financial or non-financial interests to disclose.

Ethical approval

This was an observational study of publicly available, deidentified data. The Maimonides Medical Center Research Ethics Committee has confirmed that no ethical approval is required.

Informed consent

None.

IRB approval

The study was exempt from our institution’s Institutional Review Board (IRB) approval process.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Supplementary Information

Below is the link to the electronic supplementary material.

Supplementary file1 (DOCX 16 kb)

Rights and permissions

Springer Nature or its licensor holds exclusive rights to this article under a publishing agreement with the author(s) or other rightsholder(s); author self-archiving of the accepted manuscript version of this article is solely governed by the terms of such publishing agreement and applicable law.

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Gordon, A.M., Horn, A.R., Diamond, K.B. et al. The influence of prior dental pathology on medical complications and peri-prosthetic joint infections following primary shoulder arthroplasty. Eur J Orthop Surg Traumatol 33, 1913–1919 (2023). https://doi.org/10.1007/s00590-022-03378-w

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00590-022-03378-w

Keywords

Search

Navigation