Antibiotic prophylaxis for dental or urological procedures following hip or knee replacement

Reports of prosthetic joint infection associated with urological or dental procedures have prompted suggestions that these patients require antibiotic prophylaxis, but no guidelines have been agreed. We have polled orthopaedic surgeons, urologists, and dentists on this issue.

The questions asked were: could infection of a joint prosthesis result from a dental or urological procedure; does the risk of infection warrant patients informing their dentist or urologist about their joint replacement; should these patients have prophylactic antibiotics for (a) routine procedures and (b) lengthy procedures.

Urologists and orthopaedic surgeons agreed that infection could probably result from urological procedures and that patients should definitely inform their urologist about their prosthesis. Orthopaedic surgeons thought that antibiotics were definitely indicated for routine and lengthy urological procedures while urologists thought antibiotics were probably indicated. Orthopaedic surgeons thought that infection probably could result from dental procedures, while dentists answered "don't know". Both groups agreed that patients should definitely inform their dentist about their prosthesis. Orthopaedic surgeons thought that antibiotics probably were necessary for routine and lengthy dental procedures, whereas dentists answered "probably not" and "don't know", respectively.

These results could provide the basis for a consensus regarding prophylactic antibiotic use in this growing patient population.