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American Academy of Orthopaedic Surgeons (AAOS)/American Dental Association (ADA) 2013 Guidelines for Patients with Total Joint Replacements

Recommendation 1
The practitioner might consider discontinuing the practice of routinely prescribing prophylactic antibiotics for patients with hip and knee prosthetic joint implants undergoing dental procedures.

Grade of Recommendation: Limited

A limited recommendation means the quality of the supporting evidence that exists is unconvincing, or that well-conducted studies show little clear advantage to one approach versus another.

Recommendation 2
We are unable to recommend for or against the use of topical oral antimicrobials in patients with prosthetic joint implants or other orthopaedic implants undergoing dental procedures.

Grade of Recommendation: Inconclusive

An Inconclusive recommendation means that there is a lack of compelling evidence resulting in an unclear balance between benefits and potential harm.

Recommendation 3
In the absence of reliable evidence linking poor oral health to prosthetic joint infection, it is the opinion of the work group that patients with prosthetic joint implants or other orthopaedic implants maintain appropriate oral hygiene.

Grade of Recommendation: Consensus

A Consensus recommendation means that expert opinion supports the guideline recommendation even though there is no available empirical evidence that meets the inclusion criteria

 

The 2013 guidelines do not have any specific antibiotic regimen recommendations, or special considerations for patients with comorbidities. However, practitioners should use their clinical judgment for patient with comorbidities that are associated with increased susceptibility to bacterial infections, such as patients with immune suppressive conditions.

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