Dental Antibiotic Prophylaxis and Prosthetic Joint Infections: A Narrative Review

Prosthetic joint infection (PJI) is the 3rd most common cause of revision in total hip arthroplasty (THA) and the most common cause of revision in total knee arthroplasty (TKA). It is associated with high costs/economic burden and mortality. The most common cause of late PJI is due to haematogenous seedling of bacteria into the joint from remote site infection (RSI). Oral flora constitutes 6-13% of burden in PJI. Dental interventions in patients who have undergone joint replacement surgery (JRS) are at increased risk of PJI due to bacteraemia. Dental antibiotic prophylaxes (DAP) are known to reduce this bacteraemia which in-turn may reduce the incidence of PJI. Significant controversy exists Re: the role and use of DAP in preventing PJI. This narrative review attempts to answer key questions surrounding its use based on extensive literature review in English language over past four decades.

The existing evidence is at best low and of poor quality with few comparative clinical trials that had assessed the incidence of PJI with DAP. Several systematic reviews have concluded that the existing evidence at best is inconclusive. The best existing guideline is the updated 2017 American Academy of Orthopaedic Surgeons (AAOS)-American Dental Association (ADA): Appropriate Use Criteria (AUC) that recommends shareddecision making taking individual risk factors into consideration with patients’ input. DAP are recommended only in at-risk patients and is neither cost-effective nor recommended for all cases. The risk of PJI is highest in the first two years of JRS. Regular 6-12monthly dental visits, good oral hygiene and collaboration between Surgeons and Dentists facilitate providing a high quality of care thus minimizing the incidence of PJIs.