Thursday, December 27, 2012

Evidence insufficient to recommend antibiotics for joint replacement patients who undergo dental procedures

For years now, dentists & orthopedic surgeons have been trying to figure out  the proper protocol for protecting patients that have had total joint replacement surgeries.  Total joint includes things like hip, knee, & shoulder replacements where the entire joint becomes man made.  These surgeries are usually required for complicated situations where, for a variety of reasons, the body simply cannot heal itself back to the point where the patient can utilize the joint as before the injury.  In those cases, the natural structures are removed, and titanium prosthetics are used to recreate the joint.

 

Needless to say, these surgeries are complicated and expensive.  They can also require significant healing time as well as lots of physical therapy as the patient regains strength and range of motion.

 

Because of this, the medical community has always been extra cautious about the possibility of infection around these prosthetic joints.  If a joint becomes infected, the best case scenario involves lots of IV antibiotics and a hospital stay while the worst case scenario would require another surgery to remove the infected prosthetic and place a new one.  That is obviously something that no one wants to happen.

 

So, in order to help prevent these types of scenarios, patients undergoing certain invasive procedures have been given antibiotics before treatment.  The idea being that certain procedures, such as invasive dental procedures, can release bacteria into the blood stream that could potentially settle into the joint and create an infection.  The reasoning was that by having a pre-procedure circulating dose of antibiotics in the bloodstream, the bacteria are killed before having a chance to cause problems.  However, giving antibiotics has its own potential for problems and inherent risks.  There is also the matter of scientific proof.  Just because bacteria are released during a procedure does not guarantee that they will cause problems.

 

For years there has been a debate about whether the antibiotic prophylaxis, as it is called, was needed or could even be proven to be needed.  Now comes word from the American Academy of Orthopedic Surgeons and the American Dental Association that evidence for this protocol is insufficient.

 

For the full story, follow this link to a great article by Dental Tribune that summarizes the whole situation.  

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