Thornhill M H, Gibson T B, Pack C et al. Quantifying the risk of prosthetic joint infections after invasive dental procedures and the effect of antibiotic prophylaxis. J Am Dent Assoc 2023; 154: 43-52.
Prophylaxis still recommended in the USA.
Overall, 2.9 million damaged joints are replaced with artificial joints annually worldwide. Strategies are in place to reduce post-operative infection but late periprosthetic joint infection (LPJI) can be catastrophic resulting in further surgery, and possibly amputation and/or death. The belief that bacteraemias from invasive dental procedures (IDPs) causes LPJIs leads surgeons (in the USA) to insist on antibiotic prophylaxis (AP) before IDPs.
Using data from Medicare, Medicaid and linked dental databases, 2,344 patients who developed LPJIs in a ten-year period to 2019 were identified. In the 15 months preceding LPJI admission to hospital, 1,821 IDPs were performed. Of these IDPs, 18.3% were covered by AP. The authors found no association between IDPs and subsequent LPJI. AP cover for IDPs had no significant effect in reducing the incidence of LPJIs.
'The continued use of AP poses an unnecessary threat to patients from adverse drug reactions and to society from the potential of AP to promote development of antibiotic resistance,' and should cease.
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Hellyer, P. Joint replacement and antibiotic prophylaxis. Br Dent J 234, 326 (2023). https://doi.org/10.1038/s41415-023-5634-y