The need for antibiotic coverage for dental treatment of patients with joint replacements

https://doi.org/10.1016/0030-4220(83)90300-6Get rights and content

Abstract

Patients with major joint prostheses, particularly total hip replacements, have an incidence of postoperative infection of about 1.3 percent. About 50 percent of the cases will occur within 3 months following surgery. Most cases are thought to be due to contamination of the wound at the time of surgery. About 0.3 percent of the THR cases develop infections due to hematogenous spread of bacteria from a distant site. In most cases there is active infection at the distant site and when the THR becomes infected the patient is acutely ill and the death rate is about 18 percent. In about 0.04 percent of the cases an active dental infection was thought to be the cause of the THR infection. No cases of THR infections have been documented as being caused by transient bacteremias secondary to dental manipulations. However, experimental studies have shown that transient bacteremias can infect total joint replacements in the rabbit. In addition, in about 20 to 40 percent of the patients with THR infections of hematogenous origin the site of origin could not be established; some of these cases could be of dental origin.

The current practice of using prophylactic antibiotics before and following most dental procedures in patients with THR or other major joint replacements must be questioned from several viewpoints. The first, and most basic, relates to whether it is needed. Second, do the well-known complications associated with antibiotic prophylaxis outweigh the benefits of protecting against the extremely low risk of joint replacement infection secondary to transient bacteremias of dental origin? If future research establishes the need for prophylactic antibiotics to protect against transient bacteremias of dental origin from infecting joint replacements, then a standard approach to drug selection, dosage, and duration needs to be established on the basis of sound clinical studies and scientific information.

It would appear that antibiotic prophylaxis prior to dental treatment is not indicated for patients with minor joint replacement or those who have screws or pins placed for bone fractures.

When patients with major joint replacements develop dental infections, they must be treated with speed and effectiveness to prevent possible hematogenous spread to the replacement site. This treatment should include consultation with the patient's orthopedic surgeon.

References (27)

  • R.H. Fitzgerald et al.

    Contamination of the Operative Wound

    Orthop. Clin. North Am

    (1975)
  • R. Mulligan

    Late Infections in Patients With Prostheses for Total Replacement of Joints; Implications for the Dental Practitioner

    J. Am. Dent. Assoc

    (1980)
  • P.D. Wilson et al.

    The Problem of Infection of Total Arthroplasty of the Hip

    Surg. Clin. North Am

    (1975)
  • R.Y. Hori

    The Number of Total Joint Replacements in the United States

    Clin. Orthop

    (1978)
  • R.H. Fitzgerald et al.

    Deep Wound Sepsis Following Total Hip Arthroplasty

    J. Bone Joint Surg

    (1977)
  • G. Blomgren

    Hematogenous Infection of Total Joint Replacement; an Experimental Study in the Rabbit

    Acta Orthop. Scand. [Suppl.]

    (1981)
  • A. Carlsson et al.

    Prophylactic Antibiotics Against Early and Late Deep Infections After Total Hip Replacements

    Acta Orthop. Scand

    (1977)
  • A. Ahlberg et al.

    Hematogenous Infection in Total Joint Replacement

    Clin. Orthop

    (1978)
  • Recommendations for the Control of Subacute Bacterial Endocarditis Following Dental Procedures

    Circulation

    (1977)
  • L.J. Peterson

    Prosthetic Joint Infection and Dental Procedures (Letter)

    J. Am. Dent. Assoc

    (1980)
  • J. Charnley

    Low Friction Arthroplasty of the Hip: Theory and Practice

    (1979)
  • M.E. Muller

    Late Complications of Total Hip Replacement

  • A. Schwan et al.

    Airborne Contamination and Postoperative Infection After Total Hip Replacement

    Acta Orthop. Scand

    (1977)
  • Cited by (37)

    • Antibiotics and antiseptics in periodontal therapy

      2011, Antibiotics and Antiseptics in Periodontal Therapy
    View all citing articles on Scopus

    Professor and Chairman of Oral Diagnosis and Radiology.

    View full text