AAOS Updates Clinical Practice Guideline to Prevent TKA & THA Periprosthetic Joint Infection

The American Academy of Orthopaedic Surgeons (AAOS) issued an updated Clinical Practice Guideline(CPG) for the Prevention of Total Hip and Knee Arthroplasty Periprosthetic Joint Infection (PJI) in Patients Undergoing Dental Procedures. This replaces the previous guideline from 2012. 

The updated CPG was jointly developed by the AAOS and the American Association of Hip and Knee Surgeons, with contributions from the Infectious Disease Society of America, the Musculoskeletal Infection Society, and the American Dental Association.

The CPG supports patients who are scheduled for or have undergone total joint arthroplasty (TJA) and may need dental procedures by addressing antibiotic use and the timing of dental procedures before or after joint replacements, such as total knee arthroplasty (TKA) or total hip arthroplasty (THA) to help prevent infection.

The workgroup studied the latest data to provide clinically backed evidence for orthopedists and dentists aimed at prevention and weighed it against potential patient harm. The updated guideline includes two limited-strength options and three consensus options. Options are developed when little or no evidence exists on a particular topic.

“Dental procedures are believed to possibly allow bacteria to enter the bloodstream and attach themselves to hip or knee implants, potentially causing PJI in a patient,” said Yale Fillingham, MD, FAAOS, co-chair of the AAOS’ guideline development group. “PJI is one of the most devastating complications for patients following TJA, and we must do everything possible that is supported by evidence to prevent these infections. Given the large number of annual TJA procedures and that most of these patients undergo a dental cleaning at least twice a year, this CPG is relevant to nearly every TJA patient.”

The limited-strength option states that routine use of a systemic prophylactic antibiotic before a dental procedure in patients with a hip or knee replacement may not reduce the risk of a subsequent PJI.

The second limited-strength option states that screening patients who have received certain dental procedures before their hip or knee replacement may not reduce the risk of subsequent PJI. 

The workgroup also developed a new resource with suggested time intervals between dental procedures and TJA that supports two consensus statements. These statements address whether to delay an arthroplasty after a dental procedure or delay a dental procedure after TKA or THA.