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After I've had my hip or knee replaced, will I need to take an antibiotic before having dental work done?

Henry I. Bussey, Pharm.D., FCCP, FAHA
January, 2007

Patients who undergo a hip or knee replacement are usually treated with preventive anticoagulation for 4 to 5 weeks following the procedure. This period of preventive anticoagulation may be continued longer in some circumstances if the patient is not fully mobile or if other risk factors are present. The concern about dental procedures arises for two reasons. First, having an artificial substance in the body can provide a "safe haven" for bacteria to grow and cause an infection. Dental procedures are known to release bacteria from the mouth into the blood stream. Therefore, the dental procedure may increase the risk of the patient developing an infection at the location of the artificial joint. Second, there are a number of antibiotics that may interact with warfarin and either increase or decrease the effect of warfarin. Antibiotics in this situation are usually only administered for just a day or two so that a significant interaction with warfarin is usually not encountered. Of course, after the course of warfarin has been completed, any concern about such a warfarin - antibiotic interaction is not an issue. The issue about the risk of infection associated with dental procedures, however, remains as long as the artificial joint is in place.

The American Academy of Orthopedic Surgeons (AAOS) and the American Dental Association (ADA) have reviewed this issue and have published a joint position statement on this issue which has been updated and is available at www.ada.org/
prof/resources/pubs/jada/reports/report_prophy_statement.pdf.

According to their updated statement, preventative antibiotics are not recommended routinely for joint replacement patients who are undergoing dental procedures. However, preventative antibiotics are recommended for certain high risk patients and/or those undergoing certain types of procedures. The report also includes a document at the end that can be distributed to patients to remind them and/or their physicians and dentists when preventative antibiotics are recommended and when they are not. The entire report is available at: www.ada.org/
prof/resources/pubs/jada/reports/report_prophy_statement.pdf.

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