Relation between mouth and haematogenous infection in total joint replacements

BMJ. 1994 Aug;309(6953):506-8. doi: 10.1136/bmj.309.6953.506.


Objective: To investigate the source of infections associated with orthopaedic prostheses.

Design: Analysis of four infections of prosthetic joints with case records; minimum inhibitory and minimum bactericidal concentrations and sodium dodecylsulphate polyacrylamide gel electrophoresis of the cell wall polypeptides of the Streptococcus sanguis isolates from the mouth and infected prostheses; examination of the patients' mouths for periodontal disease and caries.

Subjects: Four adults (three men) aged 58-83.

Results: For each patient the strain of S sanguis isolated from the mouth was indistinguishable from that isolated from the prosthesis. All patients had severe periodontal disease and caries.

Conclusions: The mouth was probably the source of bacterial infection in the prosthetic joints of these patients; the route of infection was possibly haematogenous. Incipient oral infection should be treated before joint replacement, and oral health should be maintained indefinitely.

MeSH terms

  • Aged
  • Aged, 80 and over
  • Bacterial Typing Techniques
  • Electrophoresis, Polyacrylamide Gel
  • Female
  • Hip Prosthesis
  • Humans
  • Joint Prosthesis*
  • Knee Prosthesis
  • Male
  • Microbial Sensitivity Tests
  • Middle Aged
  • Mouth / microbiology*
  • Periodontal Diseases / microbiology
  • Prosthesis-Related Infections / microbiology*
  • Prosthesis-Related Infections / transmission
  • Streptococcal Infections / microbiology*
  • Streptococcal Infections / transmission
  • Streptococcus sanguis / isolation & purification*