Antibiotics for Total Joint Replacement

Prevention of Orthopaedic Implant Infection in Patients Undergoing Oral Surgery Procedures

Recommendation 1 

The practitioner might consider discontinuing the practice of routinely prescribing prophylactic antibiotics for patients with hip and knee prosthetic joint implants undergoing dental procedures.

Grade of Recommendation: Limited

A Limited recommendation means the quality of the supporting evidence that exists is unconvincing, or that well-conducted studies show little clear advantage to one approach versus another. Practitioners should be cautious in deciding whether to follow a recommendation classified as Limited, and should exercise judgment and be alert to emerging publications that report evidence. Patient preference should have a substantial influencing role.

Recommendation 2 

We are unable to recommend for or against the use of topical oral antimicrobials in patients with prosthetic joint implants or other orthopaedic implants undergoing dental procedures.

Grade of Recommendation: Inconclusive

An Inconclusive recommendation means that there is a lack of compelling evidence resulting in an unclear balance between benefits and potential harm. Practitioners should feel little constraint in deciding whether to follow a recommendation labeled as Inconclusive and should exercise judgment and be alert to future publications that clarify existing evidence for determining balance of benefits versus potential harm. Patient preference should have a substantial influencing role.

Recommendation 3

In the absence of reliable evidence linking poor oral health to prosthetic joint infection, it is the opinionof the work group that patients with prosthetic joint implants or other orthopaedic implants maintain appropriate oral hygiene.

Grade of Recommendation: Consensus

A Consensus recommendation means that expert opinion supports the guideline recommendation even though there is no available empirical evidence that meets the inclusion criteria. Practitioners should be flexible in deciding whether to follow a recommendation classified as Consensus, although may set boundaries on alternatives. Patient preference should have a substantial influencing role

AAOS-ADA EVIDENCE BASED GUIDELINE AND EVIDENCE REPORT 2012

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