Frequent Dental Scaling Is Associated with a Reduced Risk of Periprosthetic Infection following Total Knee Arthroplasty: A Nationwide Population-Based Nested Case-Control Study.

Chia-Jung Ho,Tzu-Chieh Lin,Ta-Wei Tai,Peter M. Milgrom,Yea-Huei Kao Yang,Chyun-Yu Yang

doi:10.1371/journal.pone.0158096

Chia-Jung Ho, Tzu-Chieh Lin + Show 4 more

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https://doi.org/10.1371/journal.pone.0158096

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Abstract

Oral bacteremia has been presumed to be an important risk factor for total knee arthroplasty (TKA) infection. We aimed to investigate whether dental scaling could reduce the risk of TKA infection. A nested case-control study was conducted to compare 1,291 TKA patients who underwent resection arthroplasty for infected TKA and 5,004 matched controls without infection in the TKA cohort of Taiwan’s National Health Insurance Research Database (NHIRD). The frequency of dental scaling was analyzed. Multiple conditional logistic regression was used to assess the frequency of dental scaling and the risk of TKA infection. The percentage of patients who received dental scaling was higher in the control group than in the TKA infection group. The risk for TKA infection was 20% lower for patients who received dental scaling at least once within a 3-year period than for patients who never received dental scaling. Moreover, the risk of TKA infection was reduced by 31% among patients who underwent more frequent dental scaling (5–6 times within 3 years). Frequent and regular dental scaling is associated with a reduced risk of TKA infection.

Highlights

Total knee arthroplasty (TKA) is currently the best solution for decreasing knee pain and improving function in patients with end-stage osteoarthritis, rheumatoid arthritis, and other rheumatic diseases
From 1999–2002, a total of 32,391 patients who had recently undergone TKA were included in the TKA cohort
The authors revealed that the patients with gingival disease (GI > 1.5) had a higher risk of bacteremia after tooth brushing (OR: 2.77; 95% confidence interval (CI), 1.5–5.1) than those with relatively healthy gingiva (GI < 1.5)

Summary

Introduction

Total knee arthroplasty (TKA) is currently the best solution for decreasing knee pain and improving function in patients with end-stage osteoarthritis, rheumatoid arthritis, and other rheumatic diseases. As life expectancy has increased, the number of patients requiring TKA is growing exponentially. In 2005, approximately 500,000 TKAs were performed in the United States. This number is expected to increase to 3,500,000 by 2030, according to one projection[1]. There are more than 20,000 TKAs performed per year in Taiwan. All of the expenses associated with surgery and hospitalization are covered by the National Health Insurance (NHI) system

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