Antibiotic Prophylaxis Is Not Necessary for Invasive Dental Procedures in Existing Total Knee Arthroplasty Implants

Abstract

Antibiotic prophylaxis before an invasive dental procedure (IDP) for patients with preexisting knee implants has been suggested, but its use has yet to reach consensus. Therefore, we sought to examine antibiotic prophylaxis before an IDP for patients who had undergone a total knee arthroplasty (TKA). We specifically assessed 90-day to 1-year (1) periprosthetic joint infection (PJI) and (2) revision. We queried a national, all-payer database for patients undergoing primary TKA between 2010 and 2020 (n=1,952,917). We identified IDP, as defined by any procedure that involves gingival manipulation, and stratified according to antibiotic prophylaxis. A control cohort of TKA recipients without subsequent IDP was then established. All 3 cohorts were matched according to demographic and health metrics (n=496). Chi-square testing generated the odds ratio (OR) with 95% CI for postoperative PJI and revision. The odds for PJI and revision at all time points were statistically similar between antibiotic prophylaxis and no antibiotic prophylaxis (PJI: OR, 0.62; 95% CI, 0.11–4.00; P ≥.479; revision: OR, ≥0.33; 95% CI, 0.03–4.00; P ≥.248). Additionally, both IDP cohorts and the control cohort had similar rates of postoperative PJI ( P ≥.367) and revision ( P ≥.173) at all time points. Antibiotic prophylaxis before an IDP for TKA recipients did not decrease the risk of PJI or revision up to 1 year after the index procedure. These results support the trend by dentists and orthopedic surgeons to refrain from antibiotic prophylaxis. However, it likely has utility in patients at high risk, as suggested by current guidelines. [ Orthopedics . 2023;46(2):76–81.]