Post-Operative Instructions

Ballarat Orthopaedics & Sports Medicine

Helpful Information About Your Surgery

Dental Information

Patients with Joint Replacements who Require Dental Treatment.

Dental problems in the first 3 months following hip or knee joint placement surgery

Infection with abscess formation: Urgent and aggressive treatment of the abscess. Remove the cause (exodontic or endodontic) under antibiotic prophylaxis.

Pain: Provide emergency dental treatment for pain. Antibiotics are indicated if a high or medium risk dental procedure is performed.

Non-infective dental problem without pain: Defer non-emergency dental treatment until 3 to 6 months after prosthesis replacement.

Dental treatment after 3 months in a normal patient with a normally functioning artificial joint

Routine dental treatment including extraction – No antibiotic prophylaxis required.

Immunocompromised patients are a particular risk:

Failing, particularly chronically inflamed, artificial joints:

Consultation with the patient’s treating orthopaedic surgeon is recommended.
Defer non-essential dental treatment until the orthopaedic problem has been resolved.

Previous history of infected artificial joints:

Consider if the patient is immunocompromised.
Routine non-surgical dental treatment – no prophylaxis indicated.

Recommended antibiotic regimens where indicated:

  1. Dental clinic local anaesthetic extractions or deep curettage- Amoxycillin 2-3g orally 1 hour prior to procedure
  2. Theatre procedures- Amoxycillin 1g I/V at induction and followed by 500mg amoxicillin I/V or orally 6 hours later.
  3. Penicillin hypersensitivity, long term penicillin, recent penicillin/other B-lactam- Clindamycin 600mg 1 hour prior to procedure or Vancomycin 1g I/V 1 hour to finish 2 hours or Lincomycin 600mg just prior to the procedure.
  4. High risk case (i.e. Gross oral sepsis/severely immunocompromised/previous joint infection) – Gentamicin 2mg/kg I/V just before procedure (can be administered 3mg/kg provided there is no concomitant renal disease) PLUS Amoxycillin 1g I/V just before procedure and followed by 500mg I/V or orally hours later.

If hypersensitive to penicillin replace amoxycillin with Vancomycin 1g I/V over 1 hour to finish just before procedure.

Ref: Scott JF et al, Patients with artificial joints: do they need antibiotic cover for dental treatment? Aust Dent J 2005:50 Suppl 2S45-S53

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