Osteoarthritis and Total Joint Atrhoplasty

Question 1

Osteoarthritis is a _____ joint disease that has a ____ onset

Answer 1

Degenerative; gradual

Question 2

Describe what happens in osteoarthritis

Answer 2

Progressive deterioration of hyaline cartilage and underlying bone of joint

Question 3

What parts of the body does osteoarthritis most commonly affect?

Answer 3

Knees, hips, hands

Question 4

Which specific joints are most impacted with osteoarthritis?

Answer 4

Weight-bearing joints

Question 5

Osteoarthritis typically begins after age ____; almost all adults affected by age ____

Answer 5

40; 80

Question 6

Risk factors for osteoarthritis

Answer 6

Injury, abnormal motion, metabolic disorders, joint infection, obesity

Question 7

Symptoms of osteoarthritis

Answer 7

Pain, joint stiffness, swelling, loss of function

Question 8

Radiographic findings of osteoarthritis

Answer 8

Joint space narrowing, osteophytes, bony sclerosis

Question 9

What two things can reduce symptoms of osteoarthritis?

Answer 9

Early diagnosis and treatment

Question 10

Disadvantages of using NSAIDs chronically for Osteroarthritis

Answer 10

• Drug interactions
• Risk for adverse cardiac events
• Risk for GI ulceration and bleeding

Question 11

What is the second most common cause of prosthetic joint failure?

Answer 11

Infections

Question 12

What is the primary cause of prosthetic joint failure?

Answer 12

Aseptic loosening

Question 13

Factors with Higher risk for prosthetic joint infection

Answer 13

• Prior joint surgery
• Failure to give antimicrobial prophylaxis during joint replacement surgery
• Immunosupression
• Perioperative wound complications
• High ASA score
• Prolonged operative time
• History of prosthetic joint infection

Question 14

What is a risk factor for hematogenous prosthetic joint infection?

Answer 14

Bacteremia; especially Staphylococcus aureus

Question 15

Tooth brushing and chewing can result in transient bacteremia in ___% of episodes

Answer 15

40%

Question 16

Staph are _____ implicated in bacteremia following dental procedures

Answer 16

Rarely

Question 17

What type of bacteria constitute the most of facultative oral flora?

Answer 17

Viridans-group Streptococci

Question 18

What type of bacteria cause transient bacteremia after dental procedures that result in trauma to gingiva or oral mucosa?

Answer 18

Viridans-group Strep

Question 19

Viridans-group Strep accounts for only __% of all hematogenous prosthetic joint infections.

Answer 19

2%

Question 20

Cumulative exposure to transient bacteremia through daily activities is several times ____ than following a single exposure during a dental procedure.

Answer 20

Higher

Question 21

Three examples of transient, low-grade bacteremia activities.

Answer 21

1. Dental Procedures
2. Tooth brushing
3. Chewing

Question 22

High risk and low risk dental procedures were not risk factors for joint infections in what subgroups?

Answer 22

1. Immunocompromised
2. Diabetics
3. Had prior athroplasty
4. Had duration of prosthetic joint infection symptoms of <8 days
5. Were within a year of joint athroplasty

Question 23

Which type of antibiotic do orthopedic surgeons prefer? why?

Answer 23

Cephalosporins rather than amoxicillin; because it enters the synovial fluid

Question 24

In general, for patients with prosthetic joint implants, prophylactic antibiotics are ____ recommended prior to dental procedures to prevent PJI.

Answer 24

Not