Prosthetic joints

Question 1

Define prosthetic joint. Indicate which joints are commonly replaced

Answer 1

Prosthetic joint - a faulty joint is replaced with an artificial joint via replacement surgery

Commonly replaced joints:

• Hip
• Knee
• Ankle
• Shoulder
• Elbow
• Finger

Question 2

Explain the issues associated with the use of antibiotic prophylaxis and prosthetic joints

Answer 2

• Oral bacteria can enter the blood stream in numerous ways: Chewing, brushing, dental treatment (not significantly higher than everyday activities)
• Periodontal disease increased bacteraemia
• Artifical joints are vulnerable to colonization by bacteria
• Can oral bacteria colonize joints? Yes but very low risk of oral related infection (0.04-0.07%)
• Can prophylaxis antibiotics prevent oral bacteria from entering blood stream? Does not lower bacteria count, can inhibit colonization
• Risk-benefit analysis:
  1) 30 per 100,000 patients with joint replacement will have infection due to dental treatment
  2) 40 per 100,000 patients will have an anaphylaxis allergic reaction; 4 will die
  3) Do NOT give prophylaxis antibiotics for dental treatment, unless significant risk factors are present

Question 3

Identify guidelines about managing dental patients who have prosthetic joints

Answer 3

• Before joint replacement surgery, ensure patient is orally fit
• Give prophylaxis antibiotics if dental infection (with abscess) within 3 months of joint placement, where joint is still not properly stabilized yet
• Do NOT give prophylaxis to patients that have stabilized, functioning artifical joint unless: they have history of infected joints, having extraction or deep periodontal scaling.

Overall: Patients with high risk of joint infection should be identified prior to dental treatment, and then decision on prophylaxis antibiotics can be made.