#United States #Rosemont #AAOS Guidelines #Joint Infection #Dental Procedures

Updated AAOS Guidelines for Dental Procedures

The American Academy of Orthopaedic Surgeons (AAOS) has recently issued a significant update to its Clinical Practice Guideline (CPG) regarding the prevention of periprosthetic joint infections (PJI) in patients undergoing total hip and knee arthroplasties who also require dental treatments. This new guideline replaces the previous version from 2012 and reflects the latest in evidence-based recommendations, underscoring the importance of mitigating infection risks for patients who have received total joint arthroplasties.

Dr. Yale Fillingham, co-chair of the AAOS guideline development group, emphasized the crucial nature of this guideline, stating, "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." As PJI can lead to devastating consequences for patients following total joint arthroplasty, the CPG aims to provide a supportive framework for those with hip and knee replacements who may need to undergo dental procedures.

The Prevalence and Risks of PJIs

Total hip arthroplasties (THA) and total knee arthroplasties (TKA) rank among the most frequently performed surgical interventions globally. In the U.S. alone, over 1 million such procedures are completed each year, with projections suggesting increases of 659% and 469%, respectively, by 2060. Alarmingly, PJI complications can elevate mortality rates substantially—by up to 250%, when compared to patients without infections. Addressing how dental treatments may contribute to such risks is therefore critical for healthcare providers.

The CPG includes a careful evaluation of recent data to offer backing for orthopaedic surgeons and dental professionals. It presents limited-strength options and consensus options, addressing scenarios where evidence may be lacking. For example, one significant finding states that routine preoperative systemic prophylactic antibiotics may not effectively decrease the risk of PJI in patients with hip or knee replacements undergoing dental work.

Dr. Charles Hannon, another co-chair of the guideline development group, elucidates, "The committee rigorously analyzed the data concerning antibiotic administration prior to dental procedures. We found no definitive evidence that such practices mitigate the risk of PJI stemming from dental work." However, he added that there may be specific cases where an individual patient's circumstances warrant antibiotic prescriptions and decisions should be made collaboratively with the patient.

Key Recommendations of the Updated Guidelines

The updated guideline gives rise to a handy reference tool that aids healthcare providers in determining appropriate timing between dental procedures and total joint arthroplasty schedules. Key insights include:

• - Non-invasive dental procedures such as examinations and oral hygiene treatments should not pose a risk and can be performed up to the day before elective total joint surgeries.
• - Oral surgeries and extractions, which necessitate longer healing periods, should ideally be completed at least three weeks prior to arthroplasties.
• - A majority of dental treatments following TJA should be postponed for up to three months, depending on the complexity of dental work undertaken.

These insights offer a framework to guide surgeons and dental professionals on managing patient care effectively while minimizing infection risks following joint replacement surgeries. The guideline's development combined input from multiple credible organizations, including the American Association of Hip and Knee Surgeons and the Infectious Disease Society of America, demonstrating a collaborative approach to improving patient safety.

The updated CPG serves not just as a clinical reference but also as an educational tool for those handling cases of PJI related to TKA and THA. It's crucial to remember that guidelines should not serve as a rigid protocol; clinical decisions must account for individual patient's unique circumstances and medical advice.

To access the full Clinical Practice Guideline, orthopaedic surgeons and dentists are encouraged to utilize the resources available on the AAOS’ OrthoGuidelines website and accompanying mobile application. The AAOS committed to advancing knowledge in musculoskeletal health holds an essential role in educating professionals on the best practices for enhancing patient outcomes.

In conclusion, the updated CPG by AAOS stands as a pivotal resource for preventing periprosthetic joint infections in patients who undergo significant joint surgeries and are subsequently in need of dental treatments. The initiative highlights the lasting commitment to patient care excellence in the orthopaedic and dental realms.