Antibiotic Prophylaxis Following Hip Replacement

Mark E. Williams, MD


February 25, 2002


What are the data or consensus recommendations for antibiotic prophylaxis for routine dental cleaning or for other more invasive but routine procedures following hip replacement?

Peter Clark, MD

Response from Mark E. Williams, MD

Nearly half a million total joint replacements are performed in the United States each year.[1] As a result, a number of patients have benefited from these procedures. While the risk of prosthetic joint infection is low (estimated between 0.5% and 5%), it is a devastating event and a major cause of prosthetic joint failure. Because bacteremias can seed joint implants, it is important to consider whether antibiotic prophylaxis should be recommended to patients with joint implants prior to dental cleaning or other routine invasive procedures.

According to an advisory statement jointly issued by the American Academy of Orthopaedic Surgeons and the American Dental Association, antibiotic prophylaxis is not routinely indicated for patients with orthopaedic plates, pins, or screws, or for patients with prosthetic joint replacement prior to undergoing dental procedures.[1] Individuals considered to have a potential for increased risk of infection include those who are immunosuppressed, have inflammatory arthropathies, insulin-dependent type 1 diabetes, malnourishment, or a history of a previous prosthetic joint infection. Potential risk for infection is considered highest in the first 2 years after joint replacement.

Some immunosuppressed patients with prosthetic joints, such as those with rheumatoid arthritis being treated with aggressive therapy, might benefit from antibiotic prophylaxis prior to dental procedures.[2] However, this recommendation is based on individualized criteria, and is not supported by extensive clinical evidence. The full advisory statement on antibiotic prophylaxis, including a stratification of dental procedures into high- and low-risk categories, is available online.[1]

It is important to remember that the mechanism of infection of prosthetic joints is different from that of infective endocarditis and prosthetic heart valves.[3] Primary care physicians should be alert for any symptoms and signs such as fever, pain, swelling, or warmth over the joint that could indicate possible infection in patients with total joint prostheses.[4]