Published 12/18/2024
During their November meeting, the AAOS Board of Directors approved the Clinical Practice Guideline (CPG) for the Prevention of Total Hip and Knee Arthroplasty (THA/TKA) Periprosthetic Joint Infection (PJI) in Patients Undergoing Dental Procedures. The guideline, which updates the 2012 version, was jointly developed by AAOS and the American Association of Hip and Knee Surgeons, with contributions from the Infectious Diseases Society of America, the Musculoskeletal Infection Society, and the American Dental Association (ADA). The guideline aims to support patients who are scheduled for or have undergone total joint replacement and may need dental procedures. The CPG addresses the role of dental screening, antibiotic prophylaxis, strategies for preventing potential PJI, and the timing of dental procedures before and after THA or TKA.
The previous 2012 CPG, codevel-oped with the ADA, included one limited recommendation, one consensus recommendation, and one inconclusive recommendation. The limited recommendation suggested that practitioners might consider stopping the routine prescription of antibiotics for patients who have undergone THA or TKA prior to a dental procedure. The consensus recommendation emphasized maintaining good oral hygiene in patients who have undergone total joint replacement. The inconclusive recommendation (a strength of recommendation which has since been discontinued in AAOS guidelines) neither supported nor opposed the use of oral antimicrobials for such patients prior to a dental procedure.
The updated guideline includes two limited-strength options and three consensus options. Options are developed when there is little or no evidence on a particular topic, as was the case with this CPG. The limited options both advised that the routine use of systemic prophylactic antibiotics before a dental procedure and dental screening prior to THA or TKA may not reduce the risk of subsequent PJI.
Two consensus options reflected the workgroup’s opinion that the timing of undergoing THA or TKA after a dental procedure, as well as the timing of a dental procedure following THA or TKA, should be carefully considered. These decisions were based on factors such as the risk of transient bacteremia, the need for an invasive dental procedure, or the presence of an active infection that is currently being treated. The final consensus option did not support the use of an oral topical antiseptic wash before a dental procedure in patients who have had hip or knee replacement surgery.
The full guideline, along with all supporting rationale and documentation, is available on OrthoGuidelines.