Are antibiotics necessary prior to dental procedures after bilateral total hip arthroplasty (THA) replacements have been done?

From the Guidelines

Antibiotic prophylaxis is generally not needed prior to dental procedures for patients with bilateral hip replacements. The American Dental Association and American Academy of Orthopedic Surgeons no longer routinely recommend antibiotics for joint replacement patients undergoing dental work, as stated in the 2015 guidelines 1. This change in guidance occurred because research has shown that the risk of joint infection from dental procedures is extremely low, and the potential harms of unnecessary antibiotic use (including antibiotic resistance and allergic reactions) outweigh the benefits.

Some of the key points to consider include:

• The risk of prosthetic joint infection (PJI) from dental procedures is extremely low, with studies showing no statistical association between high-risk procedures without antibiotic prophylaxis and PJI at 6 months or 2 years 1.
• The potential harms of unnecessary antibiotic use, including antibiotic resistance and allergic reactions, outweigh the benefits 1.
• Patients who have had complications with their hip replacements, those with compromised immune systems, poorly controlled diabetes, or those who had their replacements within the past two years might still benefit from prophylaxis 1.
• In these cases, amoxicillin 2g taken orally one hour before the dental procedure is typically recommended (or azithromycin for those with penicillin allergy), as suggested by the 2017 guidelines 1.

It's essential to discuss your specific medical history with both your orthopedic surgeon and dentist, as they may recommend prophylaxis based on your individual risk factors. The 2020 review of guidelines for dental antibiotic prophylaxis also emphasizes the importance of maintaining good oral hygiene and regular dental review to reduce the risk of infective endocarditis and prosthetic joint infections 1.

From the Research

Antibiotic Prophylaxis in Dental Procedures after Bilateral Hip Replacements

• The need for antibiotic prophylaxis in dental procedures after bilateral hip replacements is a topic of ongoing debate, with various studies presenting different findings 2, 3, 4, 5, 6.
• A study published in 2018 found that extended oral antibiotic prophylaxis substantially reduced the 90-day infection rate in high-risk patients undergoing primary total hip and knee arthroplasty 2.
• However, a more recent systematic review and meta-analysis published in 2024 suggested that single-dose antibiotic prophylaxis may be preferable for reducing periprosthetic joint infection incidence in primary total hip and knee arthroplasty 3.
• Another study published in 2022 discussed the importance of prophylactic antibiotics in reducing infection risk in total hip and knee arthroplasty, but did not specifically address the issue of dental procedures after bilateral hip replacements 4.
• A 2025 study compared the efficacy of clindamycin versus cefazolin in preventing periprosthetic joint infection in patients undergoing hip hemiarthroplasty, and found that clindamycin prophylaxis was associated with a significantly higher risk of periprosthetic joint infection 5.
• An evidence-based review published in 2019 suggested that extended antibiotic prophylaxis may be linked to lower periprosthetic joint infection rates in high-risk patients, but noted that further research is needed to more narrowly define risk factors for periprosthetic joint infection and to demonstrate the safety and efficacy of extended antibiotics 6.

Key Findings

• Extended antibiotic prophylaxis may reduce the risk of periprosthetic joint infection in high-risk patients undergoing primary total hip and knee arthroplasty 2, 6.
• Single-dose antibiotic prophylaxis may be preferable for reducing periprosthetic joint infection incidence in primary total hip and knee arthroplasty 3.
• The choice of antibiotic prophylaxis regimen may affect the risk of periprosthetic joint infection, with cefazolin potentially being more effective than clindamycin in preventing infection 5.
• Further research is needed to determine the optimal antibiotic prophylaxis regimen for patients undergoing dental procedures after bilateral hip replacements.