A Strict No-Germ Policy for My Total Joints

The incidence of a prosthetic joint infection (PJI) in primary total ankle arthroplasty (TAA) has been reported as 2.4%, according to a large cohort study. While patient related factors play an important role, the influence of dental work is also a consideration. Below are updated guidelines developed by the American Academy of Orthopaedic Surgeons (AAOS) and associated societies regarding hip and knee arthroplasty and infectious disease. 

Timing of dental procedures

• Noninvasive and minimally invasive dental care, such as dental exams (without probing), oral hygiene, and orthodontic procedures, can be performed safely until the day before elective total joint arthroplasty (TJA) surgery.

• Oral surgeries and dental extractions, which may require up to three weeks for healing, should be completed at least three weeks prior to elective TJA.

• Most dental procedures should be delayed for up to three months after TJA, depending on the type of procedure performed.

Dental prophylaxis

The guideline development group from the AAOS issued a limited-strength opinion regarding the use of a systemic prophylactic antibiotics before dental procedures in patients with a hip or knee replacements. They concluded that routine antibiotic use may not reduce the risk of developing a prosthetic joint infection (PJI) afterword. According to the best available data, no studies have shown that administering antibiotics before dental work affects the likelihood of a periprosthetic joint infection. However, it’s important to recognize there may be other factors that could lead a healthcare provider to prescribe antibiotics for a specific patient. This decision should be made collaboratively with the patient, considering their unique risks and benefits.