Why is this Procedure

Performed?

The main reason for the performing of

these procedures is pain caused by
severe arthritis. The National Institutes
of Health says, The results of a total
knee replacement are often excellent.
The operation relieves pain for most
people. Most people do not need help
walking after they fully recover.

What Does This Procedure

Entail?

These
procedures
involve removing
damaged tissue
from the joint and
replacing it with
artificial tissue
that is known as
a prosthetic .

How Many People Are

Affected?

According to the Agency for

Healthcare Research and Quality,
In 2010, there were more than
302,000 hip replacement and
658,000 knee replacement
procedures performed in the
United States.

What is the Significance of

a Hip, Knee or Joint
Replacement
to ajoints
Dental
The presence of artificial
in a patient
affects the way that we will treat the patient,
Hygienist?
therefore, it is important that we discuss
their past procedures with them at their
initial evaluation. Knowing about a patients
knee, hip or other joint replacement is
important because they are considered a
high-risk patient for a infection around the
prosthetic up to two years after their
surgery and require a medical consultation
and antibiotic pre-medication prior to any
dental treatment.

Additional Questions to
Ask
When were the joints placed?
Were there any complications?
Are you taking any medications because of
your prosthetic joint?
If so, what type of medications are you
taking?

Why are Pre-Antibiotics

Important
to
Joint
Pre-Antibiotics reduce the risk of bacteria entering
Replacement
Patients?
the patients blood stream
in the oral cavity and

making its way to the artificial joint where it could

settle and cause major problems. If the patient has
had a joint replacement in the last 2 years, they
need to be pre-medicated for any procedure that has
any chance of causing bleeding. If they have an
antibiotic in their system there is a greater chance
that the bacteria will be destroyed in the blood
stream. The job of a dental clinician is not only to
promote optimal dental health, but also optimal
overall health, as well, including their prosthetic
joints.

How Long Does an Artificial

Joint
Last?
Most artificial knee joints last

10 to 15 years. Some last as

long as 20 years before they
loosen and need to be
replaced again, and of hip
replacements, Some people
may have problems with
infection, loosening, or even
dislocation of the new hip
joint. Over time sometimes
as long as 15 - 20 years the
artificial hip joint will loosen.
You may need a second
replacement. Younger, more
active people may wear out
parts of their new hip. It may
need to be replaced before
the artificial hip loosens.
(National Institute of Health)

Medications

Directly after a knee, hip or other joint

replacement surgery the patient be
taking some pain medications or blood
thinners, but this is on a very short term
basis. However, there are several
antibiotics that could be prescribed to
the patient prior to dental treatment
during their first two years after surgery.

Pre-Medications:

Each of these premedications are to be taken

orally, one hour before the
invasive (any procedure
that may cause bleeding)
dental procedure.
Ampicillin (2000 mg)
Clindamycin (600 mg)
Cephalexin (2000 mg)
Amoxicillin (2000 mg)
Cephradine (2000 mg)

What Happens if an
Infection Does Occur?

If the infection spreads deep into the joint

then surgery may be required, of which
there are two options. The first is called a
debridement. According to the American
Academy of Orthapaedic Surgeons, during
a debridement, your surgeon removes all
contaminated soft tissues. The implant is
thoroughly cleaned, and plastic liners or
spacers are replaced. After the procedure,
IV antibiotics will be prescribed for
approximately 6 weeks.

Infection Treatment
Continued

If the infection is more advanced a much

more invasive surgery will be required
known as staged surgery. The first stage
of this treatment includes: the removal of
the implant, a washout of the joint and soft
tissues, the placement of an antibiotic
spacer, and treatment with IV antibiotics
[after about six weeks depending on the
patients condition] your surgeon will
remove the antibiotic spacer, repeat
washout of the joint, and re-implant new
total knee or hip components.

SAVE YOUR PATIENTS THE RISK OF

GETTING AN INFECTION!!! Always be
sure to conduct a thorough interview of
a patients medical history and be sure
to ask follow-up questions. Your actions
as a dental hygienist could save a life.

Exam Questions

True or False: The prescribing of antibiotic

pre-medications to patients who have had
a hip, knee or other joint replacement in the
last two years is an unnecessary
precaution and provides no health benefits.
FALSE: antibiotics help to prevent the
spread of bacteria from the oral cavity to an
artificial joint which may cause a severe
infection. (American Academy of Orthopaedic Surgeons)

Exam Questions
Continued

All of the following are possible options for

antibiotic premedication, except:
A. Ampicillin
B. Clindamycin
C. Aspirin
D. Amoxicillin
Answer: C; ampicillin, clindamycin, and
amoxicillin are all appropriate antibiotics to
be used for premedication. (Endodontics in
Cranberry)

Exam Questions
Continued

True or False: If a patient who has had a

hip, knee or joint replacement in the last
two years does not take antibiotic
premedication prior to dental treatment
they run the risk of getting an infection in
their artificial joint that could require
surgery to fix.
TRUE: There are two surgeries that could
have to be performed if a patient develops
an infection in an artificial joint:
debridement or staged surgery. (American
Academy of Orthopaedic Surgeons.)

Works Cited

Benjamin, C. Ma, MD. Knee Joint Replacement. Medline Plus.

National Library of Medicine and National Institutes of Health. 22 Sept.
2011. Web. 3 Feb. 2014. <
http://www.nlm.nih.gov/medlineplus/ency/article/002974.htm>
Zieve, David, MD, MHA, and David R. Eltz. Hip Joint Replacement.
Medline Plus. National Library of Medicine and National Institute of
Health. 22 June. 2012. Web. 3 Feb. 2014. <
http://www.nlm.nih.gov/medlineplus/ency/article/002975.htm>
Antibiotic Premedication of Dental Treatment. Endodontics in
Cranberry. 2012. Web. 3 Feb. 2014.
<http://www.endointheberry.com/antibiotic-premedication-for-dentaltreatment/>
Evidence Insufficient to Recommend Routine Antibiotics for Joint
Replacement Patients Who Undergo Dental Procedures. American
Dental Association. 18 Dec. 2012. Web. 3 Feb. 2014. <
http://www.ada.org/8059.aspx>
Joint Replacement Infection. OrthoInfo. American Academy of
Orthopaedic Surgeons. Oct. 2012. Web. 3 Feb. 2014.
<http://orthoinfo.aaos.org/topic.cfm?topic=A00629>