Antibiotic Prophylaxis After Total Joint Replacement
For protection against the remote possibility of blood-borne bacteria, carried from the mouth during a dental procedure, creating an infection in a total joint replacement, a combined task force of the American Academy of Orthopaedic Surgeons and the American Dental Association has made the following guideline recommendations. † ‡
During the first two (2) years following total joint replacement, all patients are advised to take an antibiotic regimen for the following dental procedures:
- Prophylactic cleaning of teeth or implants
- Intra-ligamentary local anesthetic injections
- Periodontal procedures
- Root canal procedures
- Dental extractions
- Dental implant procedures
- Reimplantation of avulsed teeth
- Initial placement of orthodontic bands
After the first two (2) years following total joint replacement, most patients are no longer advised to take an antibiotic regimen for the above dental procedures.
Some patients with certain conditions are advised to take an antibiotic regimen for the dental procedures listed above on a permanent basis following total joint replacement. These conditions include:
- A previous total joint replacement infection
- Inflammatory arthritis (rheumatoid, systemic lupus erythematosus)
- Insulin dependent diabetes
- Hemophilia
- Malnourishment
- Immunosuppression (disease, drug or radiation induced, including liver disease and or splenectomy)
The recommended antibiotic regimen (if not allergic to penicillin) is:
Amoxicillin, Cephalexin (Keflex) or Cephradine two (2.0) grams orally one (1) hour prior to the dental procedure.
For patients with a penicillin allergy, the recommended antibiotic is:
Clindamycin (Cleocin) 600 mgs orally one hour prior to the dental procedure.
Antibiotic prophylaxis is not warranted for dental procedures for patients with previously placed Orthopaedic pins, plates or screws.
The above recommendations are considered minimum guidelines. Your doctor and or dentist are ultimately responsible for making individual treatment recommendations to you based on their clinical judgment.
† The AAOS Bulletin (American Academy of Orthopaedic Surgeons), July 1997
‡ Journal of the American Dental Association, July 1997