The PJI Study
Research type
Research Study
Full title
Do Invasive Dental Procedures Cause Prosthetic Joint Infections (PJI)? - The PJI Study
IRAS ID
246818
Contact name
Martin H. Thornhill
Contact email
Sponsor organisation
University of Sheffield
Clinicaltrials.gov Identifier
ISRCTN11310789, ISRCTN clinical trials registry registration
Duration of Study in the UK
2 years, 5 months, 31 days
Research summary
Summary of Research
Prosthetic replacement of poorly functioning, painful and diseased joints is now a common surgical procedure. However, late prosthetic joint infections (LPJI), caused by blood-borne bacteria (bacteremia), are a common complication with high morbidity, and potential mortality, as well as high treatment, patient and societal costs. In an attempt to reduce the risk of LPJI, dentists in some parts of the world (particularly the US) are recommended to routinely give prosthetic joint patients antibiotics before invasive dental procedures (IDP). This is referred to as antibiotic prophylaxis (AP). The purpose of this is to reduce the risk of procedure-related bacteremia causing infection of the prosthetic joint. However, there is little evidence to demonstrate, or not, any association between IDP and LPJI and there is no clinical trial data demonstrating the efficacy, or not, of AP. Currently AP is not recommended in the UK for individuals with prosthetic joints but is in the US. Data proving or disproving any association between IDP and LPJI is urgently needed. If an association exists, then the widespread adoption of AP in the UK and elsewhere could help reduce the large number of LPJI cases and high associated treatment costs. In the US alone there are ~20,000 LPJI cases with a ~$566 million annual treatment cost. Alternatively, If no association exists, then AP is unnecessary and a clear recommendation against its use could be made. As AP is not currently recommended in the UK this would not have a significant impact other than reassuring clinicians and patients. In the US, and other countries where AP is the standard of care, however, stopping AP would save ~$60 million annually, avoid the risk of adverse reactions in those who currently receive AP and reduce the risk posed to society that AP unnecessarily promotes the development of antibiotic resistant bacteria.
Summary of Results
Our aim was to investigate if there is any association between the occurrence of invasive dental procedures (e.g. dental extractions, scaling of teeth and root canal treatment) and the subsequent development of prosthetic joint infection for patients who have prosthetic joints e.g. artificial hip or knee joints.
The study linked national data for England on NHS dental treatments, with data on hospital admissions to treat prosthetic joint infections. For those individuals who were admitted to hospital for a prosthetic joint infection, we counted the number and type of dental procedures that they experienced each month over the 15 months before being admitted for the prosthetic joint infection. If there is any causal association between invasive dental procedures and subsequent prosthetic joint infection, we would expect the number of invasive dental procedures that were performed each month in the 3-months immediately before being admitted for a prosthetic joint infection to be significantly higher than the number of these procedures performed each month over the 12 months before that.
However, the study found that there was no such increase in the number of dental procedures per month in the 3-months before admission to hospital for prosthetic joint infection. This provides strong reassurance that invasive dental procedures are not associated with an increased risk of prosthetic joint infection in those with prosthetic joints i.e. it is safe for patients with prosthetic joints to visit the dentist and to have invasive dental procedures performed if needed.
REC name
South Central - Hampshire B Research Ethics Committee
REC reference
18/SC/0387
Date of REC Opinion
29 Aug 2018
REC opinion
Favourable Opinion