Avoiding and Managing Temporomandibular Joint Total Joint Replacement Surgical Site Infections

Abstract

Surgical site infections (SSIs) are rare complications after total joint replacement (TJR); however, should an SSI occur, the clinical and economic consequences can be significant. A Medicare 5% national sample administrative dataset was used to identify and longitudinally observe patients undergoing total knee TJR for deep infections and revision surgery. In 69,663 patients undergoing elective total knee TJR, 1,400 infections (2%) were identified. The infection incidence within 2 years of implantation was 1.55%. A recent retrospective survey of 2,476 temporomandibular joint (TMJ) alloplastic TJR cases involving 3,368 joints reported that a 1.51% SSI rate occurred over a mean of 6 months postoperatively, with a range of 2 weeks to 12 years. This article discusses approaches to avoid and minimize TMJ TJR SSIs and recommends management options should early or late SSIs occur. On the basis of a review of the orthopedic SSI literature, this article will discuss TMJ TJR SSI risk, prevention, and management from a number of perspectives, including preoperative patient risk assessment, preincision antibiotic prophylaxis, anesthesia and skin preparation protocols, intraoperative surgical technique and duration of surgery, and postoperative antibiotic and follow-up regimens. Ways to avoid and manage potential risks for SSI in TMJ TJR cases are recommended. The diagnostic criteria and management protocols for both early- and late-occurring SSIs after TMJ TJR are recommended. The risk of SSI after TMJ TJR can be decreased with appropriate consideration to preoperative patient risk assessment; properly timed antibiotic prophylaxis; and intraoperative, postoperative, and postdischarge attention to detail.