The American Academy of Orthopaedic Surgeons (AAOS) has issued a new clinical practice guideline for the use and duration of antibiotics in dental patients who have undergone or are scheduled to undergo a total joint replacement, such as a total knee arthroplasty (TKA) or total hip arthroplasty (THA).
The updated guideline is designed to help prevent periprosthetic joint infections (PJIs) and replaces the 2012 version.
After reviewing the latest evidence, the new guideline contains two limited-strength recommendations and three consensus-based recommendations. Limited-strength recommendations are issued when there is little or no direct evidence. One of the recommendations states that routine use of systemic prophylactic antibiotics before dental procedures may not significantly reduce the risk of PJI in patients who have undergone hip or knee replacements.
“Dental procedures are thought to have the potential to allow bacteria to enter the bloodstream and attach to hip or knee implants, which could lead to PJIs in patients,” said Yale Fillingham, MD, co-chair of the AAOS guideline development panel. “PJIs are among the most serious complications for patients after TJA surgery, and we must do everything possible to prevent these infections in an evidence-based manner.”
The American Academy of Orthopaedic Surgeons (AAOS) highlights that PJIs are associated with increased mortality, which is 250% higher than in patients without PJIs, as well as a higher risk of developing mental health disorders. More than one million total knee replacements (TKA) and total hip replacements (THA) are performed in the United States each year, and these numbers are expected to increase by 659% and 469%, respectively, by 2060.
In Canada, the Canadian Orthopaedic Association (COA), the Canadian Dental Association (CDA), and the Canadian Association for Medical Microbiology and Infectious Diseases (AMMI) recommend against routine use of antibiotics for dental patients undergoing total joint replacements or orthopedic implants.
They recommend that patients maintain optimal oral health before and after surgery to reduce the risk of infection, and that antibiotics should only be used when there is clear evidence to support their benefit.
The World Health Organization (WHO) has also highlighted antibiotic resistance (AMR) as a global health threat, noting that inappropriate use of antibiotics jeopardizes the effectiveness of modern medicine.
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