Antibiotic Prophylaxis after Total Joint Replacement

For protection against the remote possibility of blood-borne bacteria during a dental procedure, which could be carried from the mouth to create an infection in a total joint replacement, a combined task force with representatives from the American Academy of Orthopaedic Surgeons and the American Dental Association has made the following guideline recommendations.

  • After having a total joint replacement, for the rest of their life, all patients are advised to take an antibiotic regimen for the following dental procedures:
  • Prophylactic cleaning of teeth or implants
  • Intraligamentary local anesthetic injections
  • Periodontal procedures
  • Root canal procedures
  • Dental extractions
  • Dental implant procedures
  • Implantation of avulsed teeth
  • Initial placement of orthodontic bands
  1. The recommended antibiotic regimen is:
  • For patients not allergic to penicillin antibiotics:

Amoxicillin two (2.0) grams orally one (1) hour prior to the dental procedure.

  • For patients with an allergy to penicillin antibiotics, but not to cephalosporin antibiotics:

Cephalexin (e.g. Keflex) or Cephradin two (2.0) grams orally one (1) hour prior to the dental procedure.

  • For patients with allergies to both penicillin and cephalosporin antibiotics:

Clindamycin (e.g. Cleocin) 600 mg orally one (1) hour prior to the dental procedure.

  1. Antibiotic prophylaxis is not warranted for dental procedures for patients with previously placed orthopedic pins, plates or screws (e.g. orthopedic implants that are not joint replacements).
  1. The above recommendations are considered minimum guidelines. Your doctor and/or dentist are ultimately responsible for making individual treatment recommendations to you based on their clinical judgement.