Premedication of patients undergoing dental procedures causing bacteremia after total joint arthroplasty

More than 1 million total joint replacements, mostly hip and knee, are performed each year in the United States, and the number is increasing. The American Academy of Orthopedic Surgeons has issued a new information statement that dramatically changes the need for premedication with antibiotics before dental appointments.

The prior advisory statements, jointly released in 1997 and 2003 by the American Dental Association and American Academy of Orthopedic Surgeons, recommended premedication for only 2 years after the surgical placement of the implant(s) for patients undergoing total arthroplasty and/or for immune-compromised patients. The current information statement indicates that those patients with total joint replacement should be premedicated for any dental procedure with a risk of causing bacteremia for the lifetime of the patient.

There is no well-documented, convincing published evidence with modern molecular methods of species identification in which the reported species was specific to a dental procedure in the orofacial region to the subsequently infected total joint replacement.

Further discussions between orthopedic surgeons, general medical practitioners, and dental practitioners should be encouraged to reach a mutual consensus on this controversial issue to provide the best protection for patients receiving dental treatment potentially resulting in transient bacteremia. Moreover, difficult randomized controlled trials must be conducted to determine the best treatment to minimize infections of total joint replacements and reduce morbidity and mortality.