Dental antibiotic prophylaxis does not reduce periprosthetic joint infection risk in total joint arthroplasty patients

This systematic review and meta-analysis examined the association between dental antibiotic prophylaxis and the risk of periprosthetic joint infection in adult patients who had total joint arthroplasty. The study population consisted of 157466 individuals. The setting details were not reported in the source data. The intervention involved dental antibiotic prophylaxis, while the comparator group consisted of nonantibiotic groups. The primary outcome measured was periprosthetic joint infection risk. Secondary outcomes were not reported. The follow-up duration was not reported.

The main results indicated no significant difference in periprosthetic joint infection risk between the two groups. The incidence of periprosthetic joint infection ranged from 0.07 to 0.3%. The effect size was not reported. The direction of the effect showed a slight, nonsignificant increase in risk among patients receiving antibiotics. The p-value or confidence interval was not reported.

Safety and tolerability findings were not reported. Adverse events were not reported. Serious adverse events were not reported. Discontinuations were not reported. Tolerability was not reported. This lack of safety data limits the ability to fully weigh the risks and benefits of routine prophylaxis.

These results contrast with prior landmark studies in this therapeutic area which often supported broader prophylaxis use. The current evidence suggests that routine use of prophylaxis before dental procedures in patients who have primary total hip or knee arthroplasty does not reduce the risk of periprosthetic joint infection. Current evidence supports limiting prophylaxis to select high-risk populations.

Key methodological limitations and potential biases were not reported in the source data. Funding or conflicts of interest were not reported. The absence of reported limitations suggests that the review may have relied on existing data without detailed critique of study quality or bias.

The clinical implications are clear for practice decisions. Routine antibiotic prophylaxis is not recommended for all patients with total joint arthroplasty undergoing dental procedures. Instead, clinicians should consider limiting prophylaxis to select high-risk populations. This approach aligns with current evidence and may reduce unnecessary antibiotic exposure.

Several questions remain unanswered. The specific characteristics of high-risk populations that warrant prophylaxis were not detailed. The long-term impact of antibiotic stewardship on periprosthetic joint infection rates was not reported. The optimal timing and type of prophylaxis for high-risk patients remain undefined. Further research is needed to clarify these aspects of clinical management.