RELATION BETWEEN MOUTH AND HEMATOGENOUS INFECTION IN TOTAL JOINT REPLACEMENTS

Objective-To investigate the source of infections associated with orth opaedic prostheses. Design-Analysis of four infections of prosthetic j oints with case records; minimum inhibitory and minimum bactericidal c oncentrations and sodium dodecylsulphate polyacrylamide gel electropho resis of the cell wall polypeptides of the Streptococcus sanguis isola tes from the mouth and infected prostheses; examination of the patient s' mouths for periodontal disease and caries. Subjects-Four adults (th ree 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. Ah 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 be fore joint replacement, and oral health should be maintained indefinit ely.