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Joint replacement guidelines in discussion

ADA, AAOS reviewing antibiotic prophylaxis recommendations

Rosemont, Ill.—The ADA and American Academy of Orthopaedic Surgeons are working together to develop evidence-based, clinical practice guidelines for antibiotic prophylaxis for dental patients with total joint replacement.

The new guidelines, expected to be complete by 2011, will undergo a rigorous evidence-based approach by the AAOS, ADA and others who participate in the work group put together by the AAOS Guidelines and Technology Oversight Committee.

"We thought it was time that we really looked at the evidence," said Charles M. Turkelson, Ph.D., director, AAOS Department of Research and Scientific Affairs. "This is an issue that we know jointly affects the ADA and the AAOS so we should work on it together."

"This issue has significant health implications for the patients receiving care from both orthopedic surgeons and dentists," added Dr. Dan Meyer, senior vice president, ADA Science/Professional Affairs. "It is imperative to communicate the most appropriate guidance for providers and patients and essential that the clinical recommendations be supported by evidence-based systematic reviews that are scientifically sound."
In 2009, AAOS issued an information statement for patients undergoing certain medical and dental procedures who have had a total joint replacement, saying, "Given the potential adverse outcomes and cost of treating an infected joint replacement, the AAOS recommends that clinicians consider antibiotic prophylaxis for all total joint replacement patients prior to any invasive procedure that may cause bacteremia."

This was different from the previous statement, which recommended routine antibiotic prophylaxis only within the first two years following replacement surgery and beyond two years only for patients with comorbidities that might place them at increased risk for hematogenous total joint infection (i.e., immunocompromised patients).

For more information about all AAOS guidelines and the processes by which they are developed, visit and click on the section on guidelines.