Harvard Women's Health Watch

By the way, doctor: I have a joint replacement - should I take antibiotics before procedures?

I have a joint replacement — should I take antibiotics before procedures?

Q. Do I need to take antibiotics before dental cleanings and other procedures to prevent infection in my hip prosthesis?

A. In most cases, the answer is "no." It's an important question, though, because procedures such as teeth cleaning or scaling, colonoscopy, and cystoscopy can release bacteria into the bloodstream (a condition called bacteremia). For people with a prosthetic joint, the concern is that bacteria will cause an infection by attaching to, or "seeding," the artificial joint or the surrounding tissues. But such infections are very rare. Most bacteria are handily dispatched by the immune system. And antibiotics are given at the time of surgery to replace the joint, cutting the risk of infection. The American Academy of Orthopedic Surgeons (AAOS), the American Dental Association (ADA), the American Urological Association (AUA), and the American Society of Colon and Rectal Surgeons all recommend against the use of antibiotics before dental, gastrointestinal, or urological procedures just to prevent infection in artificial joints.

That said, not all immune systems are healthy enough to mop up bacteria in the bloodstream, and some procedures are more likely than others to release bacteria into the bloodstream. The AAOS, ADA, and AUA say it's fine to consider antibiotics to prevent infection of a prosthetic joint in a patient who is very susceptible to infection or who is having a procedure that carries an especially high risk of bacteremia. People are at higher risk for infection in the first two years after joint replacement or if they've had a prior prosthetic joint infection. The risk is also higher in those who are immune-compromised or malnourished or have inflammatory arthritis, type 1 diabetes, or hemophilia. Higher-risk medical procedures include kidney stone removal, urinary tract incisions, and endoscopy of the kidney or ureter. Dental procedures most likely to cause trouble are tooth extractions, periodontal procedures, dental implants, and root canals.

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