New Guideline for the Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures

The American Dental Association (ADA) and the American Academy of Orthopaedic Surgeons (AAOS) have released a new evidence-based guideline on the Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures. The new guideline has three recommendations and replaces the previous 2009 AAOS Information Statement on Antibiotic Prophylaxis for Bacteremia in Patients with Joint Replacement.

Based on a collaborative systematic review of the scientific literature, the AAOS and the ADA have found that the evidence does not support routine prescription of antibiotic prophylaxis for patients with joint replacement undergoing dental procedures. As described in the new guideline, the AAOS-ADA recommendations are:

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.

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.

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

The AAOS and ADA have advised that these recommendations are not intended to stand alone. Treatment decisions should be made in light of all circumstances presented by the patient. Treatments and procedures applicable to the individual patient rely on mutual communication between patient, physician, dentist and other healthcare practitioners in accordance with evidence based medicine applicability.

The full guideline, executive summary, shared decision making tool and other supporting documents are available from both websites of the AAOS (www.aaos.org) and the ADA (www.ada.org).

The College's Quality Assurance Committee will be reviewing the new AAOS-ADA guideline and members can expect to receive additional information about this important subject in the new year