The American Academy of Orthopaedic Surgeons (AAOS) has issued new clinical practice guidelines on the use and timing of antibiotics for dental patients who have undergone or are scheduled for total joint replacement surgeries, such as total knee arthroplasty (TKA) or total hip arthroplasty (THA).
The updated guidelines aim to help prevent periprosthetic joint infections (PJI), replacing the 2012 version.
After reviewing the latest evidence, the new guideline includes two limited-strength recommendations and three consensus-based recommendations. Limited-strength recommendations are issued when there is little or no direct evidence. One such recommendation states that routine use of systemic prophylactic antibiotics before dental procedures in patients with hip or knee replacements may not significantly reduce the risk of PJI.
“Dental procedures are believed to possibly allow bacteria to enter the bloodstream and attach themselves to hip or knee implants, potentially causing PJI in a patient,” said Dr. Yale Fillingham, co-chair of the AAOS guideline development group. “PJI is one of the most devastating complications for patients following TJA, and we must do everything possible that is supported by evidence to prevent these infections.”
PJI increases mortality
The AAOS emphasized that PJI is associated with increased mortality, up to 250% higher than in patients without PJI, and a higher risk of mental health disorders. Each year in the U.S., more than one million TKA and THA procedures are performed, a number expected to rise by 659% and 469%, respectively, by 2060.
In Canada, the Canadian Orthopaedic Association (COA), the Canadian Dental Association (CDA), and the Association of Medical Microbiology and Infectious Disease (AMMI) Canada recommend against routine antibiotic prophylaxis for dental patients with total joint replacements or orthopedic hardware. They advise that patients maintain optimal oral health before and after surgery to reduce the risk of infections, while antibiotics should only be used when clear evidence supports their benefit.
The World Health Organization (WHO) has also highlighted antimicrobial resistance (AMR) as a global health threat, noting that inappropriate antibiotic use jeopardizes the effectiveness of modern medicine.
