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Preventing Infection - Surgical Guide To Right Posterior Total Hip Replacement (Modified/Pose Avoidance)

It is very important that you protect your artificial joint from potential infection. Some patients have increased risk following total joint surgery, as an infection can spread to the new joint through the bloodstream (the medical term for this is “hematogenous spread") from another source in your body. Please tell all of your health providers that you have an artificial joint as they may need to prescribe antibiotics before treatment. This is especially important before dental procedures and invasive urinary procedures. If you are not sure whether a procedure you are having is invasive, play it safe and inform your surgeon, who will provide additional instructions.

The following is based on the American Academy of Orthopaedic Surgeons (AAOS) guidelines and recommendations published in The AAOS Bulletin, July, 1997, and also in the Journal of American Dental Association, 1997, 128:1004-1008, to help show when antibiotic treatment is indicated.

Patients at potential increased risk of hematogenous total joint infection include:

  • Patients who are immunocompromised or immunosuppressed:
    • Inflammatory joint arthritis, rheumatoid arthritis, systemic lupus erythematosus
    • Disease, drug or radiation-induced immunosuppression
  • Other patients:
    • Insulin-dependent (Type 1) diabetes
    • Within two years following joint replacement
    • Previous prosthetic joint infections
    • Malnourishment
    • Hemophilia

There is a higher incidence of infection with certain dental procedures (procedures more likely to have bacteria enter the bloodstream):

  • Dental extractions
  • Periodontal procedures including surgery, subgingival placement of antibiotic fibers/strip, scaling and root planning, probing, recall maintenance
  • Dental implant placement and reimplantation of avulsed teeth
  • Endodontic (root canal) instrumentation or surgery only beyond the apex
  • Initial placement of orthodontic bands, but not brackets
  • Intraligamentary local anesthetic injections
  • Prophylactic cleaning of teeth or implants where bleeding is anticipated
For at least two years following surgery, please be sure to tell your internist and dentist that you have an artificial joint so that they can prescribe antibiotics prior to the above procedures. If you have any questions or concerns, please call your surgeon’s office.

The suggested antibiotic regimen is as follows:

  • For patients not allergic to Penicillin:
    • Cephalexin, cephradine or amoxicillin 2 grams orally 1 hour prior to the dental procedure
  • For patients not allergic to penicillin but unable to take oral medications:
    • Cefazolin 1gram IM/IV 1 hour prior to the dental procedure
  • For patients allergic to penicillin:
    • Clindamycin 600mg orally 1 hour prior to the dental procedure
  • For patients allergic to penicillin and unable to take oral medications:
    • Clindamycin 600 mg IM/IV 1 hour prior to dental procedure

All total joint replacement patients should adhere to this regimen for at least two years following joint replacement surgery. Some surgeons may recommend using antibiotics for longer than two years and will communicate that to their patients. Immunocompromised patients, including those with inflammatory arthropathies, rheumatoid arthritis, drug or radiation induced immunosuppression, insulin-dependent diabetes, or any other major medical problems, should follow this antibiotic routine indefinitely.

Antibiotics may reduce the risk of infection, but cannot completely eliminate that risk. Preventing infection must be the concern of YOU and all the healthcare professionals who treat you.

The lower incidence of bacteremic dental procedures (procedures less likely to have bacteria enter the bloodstream) occurs with the following dental procedures and, therefore, you do not need to take antibiotics before receiving them:

  • Restorative dentistry (operative and prosthodontic) with/without retraction cord
  • Local anesthetic injections (non-intraligamentary)
  • Intracanal endodontic treatment; post placement and buildup
  • Placement of rubber dam
  • Postoperative suture removal
  • Placement of removable prosthodontic/orthodontic appliances
  • Taking oral impressions
  • Fluoride treatments
  • Taking oral radiographs
  • Orthodontic appliance adjustment
Please note that these are guidelines for suggested regimens. The clinical judgment of the care provider may indicate antibiotic use in selected circumstances with procedures that may create significant bleeding.