Prevalence and clinical impact of dento-alveolar foci in periprosthetic joint infections: a retrospective cohort study of 213 cases

Abstract Purpose Periprosthetic joint infection (PJI) is a serious complication after total joint arthroplasty, leading to repeated revisions, substantial costs, and increased morbidity. Oral pathologies have been suggested as possible sources of hematogenous infection, however their prevalence and impact on PJI outcomes remain unclear. This study aimed to determine the prevalence of dento-alveolar foci in hip or knee PJI patients and explore differences in outcomes. Methods Patients with hip or knee periprosthetic joint infection (PJI) were retrospectively screened at a single center between 2020 and 2023. Inclusion required a confirmed diagnosis according to the 2018 International Consensus Meeting (ICM) criteria and a clinical and radiological dental assessment to identify dento-alveolar foci. Dento-alveolar foci were defined as pathological findings requiring therapeutic intervention. The primary outcome was the presence of a dental focus. Secondary outcomes included differences in outcomes, especially DAIR-failure and revision surgery rates between groups. Results Among 213 PJI cases (mean 71.9 ± 10.4 years; 52% male), dento-alveolar foci were identified in 59/213 patients (27.7%). Prevalence was similar across infection type. DAIR failure occured in 6/22 patients (27.3%) vs. 26/61 patients (42.6%; p = 0.205) and revision surgery rates were 25/59 (42.4%) vs. 79/144 (54.9%; p = 0.106). No significant differences were observed between patients with and without dental foci. Baseline characteristics and infection patterns were comparable. Conclusion Dento-alveolar foci were frequently detected in PJI patients but were not descriptively associated with differences in treatment outcomes. Immediate preemptive dental interventions may not be required during acute PJI management. Prospective studies are needed to clarify the clinical relevance of dental foci in PJI.