Do patients with bilateral hip replacements require prophylactic antibiotics for dental procedures?

From the Guidelines

Prophylactic antibiotics are not recommended for patients with bilateral hip replacements undergoing dental procedures, unless the patient has specific risk factors such as immunocompromise, diabetes, rheumatoid arthritis, previous prosthetic joint infections, or malnutrition. The current guidelines from major orthopedic and dental organizations, including the American Academy of Orthopedic Surgeons (AAOS) and the American Dental Association (ADA), no longer routinely recommend antibiotic prophylaxis for patients with prosthetic joint implants, including bilateral hip replacements 1. The risk of developing a prosthetic joint infection from dental procedures is extremely low, and there is insufficient evidence that antibiotic prophylaxis prevents such infections 1. Some studies have shown that the risk of prosthetic joint infection is not increased by dental procedures, even in high-risk patients 1. However, if antibiotics are deemed necessary, the typical regimen is amoxicillin 2g orally taken 1 hour before the dental procedure, or for those with penicillin allergy, azithromycin is now recommended over clindamycin due to the high risk of Clostridioides difficile infection (CDI) associated with clindamycin 1. This recommendation is based on the understanding that transient bacteremia from dental work rarely leads to prosthetic joint infections, and the potential harms of antibiotic use (including allergic reactions, antibiotic resistance, and side effects) often outweigh the benefits for most patients 1. Key points to consider include:

• The low risk of prosthetic joint infection from dental procedures
• The lack of evidence supporting the use of antibiotic prophylaxis in preventing prosthetic joint infections
• The potential harms of antibiotic use, including CDI and antibiotic resistance
• The importance of considering individual patient risk factors when deciding whether to use antibiotic prophylaxis.

From the Research

Prophylactic Antibiotics for Dental Work After Bilateral Hip Replacements

• The use of prophylactic antibiotics prior to dental procedures in patients with prosthetic joints is a topic of ongoing debate 2, 3.
• A study published in The Journal of Arthroplasty found that routine antibiotics prior to dental procedures did not decrease the risk of periprosthetic joint infection in patients with total hip and knee arthroplasty 2.
• The American Dental Association Council on Scientific Affairs developed an evidence-based clinical practice guideline that recommends against the use of prophylactic antibiotics in patients with prosthetic joints undergoing dental procedures, except in cases where there are significant medical risks 3.
• Another study published in the Journal of the American Dental Association found that the current best evidence failed to demonstrate an association between dental procedures and prosthetic joint infection 3.

Considerations for Patients with Bilateral Hip Replacements

• Patients with bilateral hip replacements should discuss their individual risk factors with their healthcare provider to determine the best course of action for dental procedures 3.
• The decision to use prophylactic antibiotics should be based on the patient's overall health and medical history, rather than solely on the presence of prosthetic joints 3.
• It is essential to weigh the potential benefits of antibiotic prophylaxis against the risks of antibiotic resistance and adverse reactions 2, 3.

Management of Prosthetic Joint Infections

• Prosthetic joint infections are a serious complication that requires prompt and effective treatment 4, 5.
• The management of prosthetic joint infections typically involves a combination of surgery and antimicrobial therapy 4, 6.
• The duration of antimicrobial therapy for prosthetic joint infections is a topic of ongoing research, with some studies suggesting that 6 weeks of therapy may not be sufficient 6.