AAOS updates clinical practice guideline for PJI in patients undergoing dental procedures
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Key takeaways:
- The updated clinical practice guideline from the American Academy of Orthopaedic Surgeons aims to prevent joint infection after dental procedures.
- The guideline offers options for orthopedists and dentists.
The American Academy of Orthopaedic Surgeons released an updated clinical practice guideline on periprosthetic joint infection following total joint arthroplasty in patients undergoing dental procedures, according to a press release.
“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,” Yale A. Fillingham, MD, FAAOS, co-chair of the guideline development group of the AAOS, said in the release. “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. Given the large number of annual TJA procedures and that most of these patients undergo a dental cleaning at least twice a year, this [clinical practice guideline] CPG is relevant to nearly every TJA patient.”
The guideline offers the latest clinically backed evidence including limited-strength and consensus options for both orthopedists and dentists, including statements that both routine systemic prophylactic antibiotic use in patients who underwent TJA and screening patients who have received dental procedures prior to TJA may not reduce subsequent PJI risk.
“The committee took a close look at the data on the administration of antibiotics before a dental procedure after both hip and knee replacement to see if it mitigated the potential risk of a PJI associated with that dental procedure,” Charles P. Hannon, MD, FAAOS, co-chair of the guideline development group, said in the release. “Based on the best available data, no study found that administering antibiotics before a dental procedure changed a patient's risk of getting a parasitic joint infection.”
Hannon added, “With that said, it is important to recognize there may be other considerations that may lead a provider to prescribe antibiotics for an individual patient. This decision should be made with the patient, and the unique risks and benefits for the patient should be considered.”
The AAOS workgroup also created an “at-a-glance desk reference” in accordance with three consensus options to determine whether an elective TJA operation should be delayed following a dental procedure and vice versa, according to the release.
The reference chart includes the following guidelines:
Noninvasive dental procedures and minimally invasive dental care procedures may be safely performed up until the day prior to TJA.
Oral surgeries and dental extractions should be completed at least 3 weeks prior to TJA.
Most dental procedures should be delayed until 3 months following TJA.
The full clinical practice guideline can be found at: https://www.aaos.org/globalassets/quality-and-practice-resources/dental/dental-2024/prevention-of-total-hip-and-knee-arthroplasty-pji-in-patients-undergoing-dental-procedures-cpg.pdf
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