Prophylactic antibiotics for dental work in patients with joint replacements

Let's say you're doing comanagement for a patient on the orthopedic service who has undergone total knee arthroplasty. She asks you if she'll need prophylactic antibiotics for dental work. How do you advise her?


It turns out that despite the lack of convincing evidence two professional societies have issued statements. Neither makes the claim of being a “guideline” and the two statements vary substantially in their recommendations.


The American Dental Association (ADA) has issued an advisory statement and the American Academy of Orthopedic Surgeons (AAOS) had issued an information statement. The ADA statement recommends prophylaxis in patients with certain comorbidities and those whose joint replacements were within two years. The AAOS recommendations are broader and recommend that antibiotics be considered for all patients who have ever undergone joint replacement. The AAOS statement acknowledges the role of clinical judgment in making the final decision.


BUT---


A recent study failed to support the administration of prophylactic antibiotics.


What should the clinician do? There's room for debate here. There is no strong evidence in support of antibiotics. The statements linked above, however, place a certain onus on the clinician. The administration of prophylactic antibiotics is simple and low risk. The ADA position may represent a reasonable compromise to some. There is no pat answer.