In their recent Clinical Practice Guideline ‘Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures’, the American Academy of Orthopaedic Surgeons (AAOS) reversed their 2009 informational statement, which asserted that “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.” After a comprehensive literature review by the work group, this statement was replaced with a recommendation that acknowledges the lack of evidence to support this practice. In deciding whether to endorse the most recent AAOS guideline, the SHEA Board expressed concern about the potentially confusing language of the recommendation: “The practitioner might consider discontinuing the practice of routinely prescribing prophylactic antibiotics for patients with hip and knee prosthetic joint implants undergoing dental procedures;” however, the Board ultimately voted to endorse the guideline because it overrides the 2009 guideline. SHEA’s position on the use of antimicrobial prophylaxis before dental work in patients who have prosthetic joints is that the evidence does not support its routine use.

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