The new AAOS-ADA clinical practice guideline on Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures.

Practice Guideline on Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures The American Academy of Orthopaedic Surgeons (AAOS) and the American Dental Association (ADA), with input from the Infectious Disease Society of America (IDSA), American Association of Oral and Maxillofacial Surgeons, American Association of Neurologic Surgeons, American Society of Plastic Surgeons, Musculoskeletal Infection Society, Scoliosis Research Society, American Association of Hip and Knee Surgeons, Society for Healthcare Epidemiology of America, College of American Pathologists, and The Knee Society, recently published their collaborative clinical practice guideline (CPG), Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures. This evidence-based guideline, with three recommendations, replaces the previous AAOS Information Statement, “Antibiotic Prophylaxis for Bacteremia in Patients with Joint Replacements.” That information statement contained differences from a previous advisory statement from the AAOS and ADA published in 2003. The 2003 advisory statement concluded: “The risk/benefit and cost/effectiveness ratios fail to justify the administration of routine antibiotic prophylaxis” for patients with total joint arthroplasties. The 2009 AAOS information statement promoted a different position: “Given the potential adverse outcomes and cost of treating an infected joint replacement, the AAOS recommends that clinicians consider antibiotic prophylaxis for all total joint patients prior to any procedure that may cause bacteremia.” It is important to note that an AAOS Information Statement is “an educational tool based on the opinion of the authors.” The American Academy of Oral Medicine (AAOM) followed in 2010, highlighting “...the major points of concern for a future systematic review by multispecialty collaboration.” In the meantime, given that the 2009 information statement is more an opinion than an official guideline, the AAOM believes that it should not replace the 2003 joint consensus statement prepared by the relevant organizations: the ADA, the AAOS, and the IDSA. This collaborative CPG addresses the differences in the previous approaches. The new CPG was developed using the published AAOS CPG development process, and it meets or exceeds all recommended Institute of Medicine standards for the development of systematic reviews and CPGs except for allowing patient input in the selection of topics and questions. Of note, the AAOS CPG program does not allow participation by members with relevant conflicts of interest, and the collaborating societies followed the same conflict of interest rules in selecting their members. The work group, at its first meeting, developed three recommendations regarding prophylaxis for patients with joint arthroDavid S. Jevsevar, MD, MBA