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February 2009 American Academy of Orthopaedic Surgeons
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This statement provides recommendations to supplement practitioners in their
clinical judgment regarding antibiotic prophylaxis for patients with a joint
prosthesis. It is not intended as the standard of care nor as a substitute for
clinical judgment as it is impossible to make recommendations for all
conceivable clinical situations in which bacteremias may occur. The treating
clinician is ultimately responsible for making treatment recommendations for
his/her patients based on the clinician’s professional judgment.
Any perceived potential benefit of antibiotic prophylaxis must be weighed
against the known risks of antibiotic toxicity, allergy, and development,
selection and transmission of microbial resistance. Practitioners must exercise
their own clinical judgment in determining whether or not antibiotic prophylaxis
is appropriate.
More than 1,000,000 total joint arthroplasties are performed annually in the
United States, of which approximately 7 percent are revision procedures.1 Deep
infections of total joint replacements usually result in failure of the initial
operation and the need for extensive revision, treatment and cost. Due to the
use of perioperative antibiotic prophylaxis and other technical advances, deep
infection occurring in the immediate postoperative period resulting from
intraoperative contamination has been markedly reduced in the past 20 years...
...Patients with joint replacements who are having invasive procedures or who
have other infections are at increased risk of hematogenous seeding of their
prosthesis. Antibiotic prophylaxis may be considered, for those patients who
have had previous prosthetic joint infections, and for those with other
conditions that may predispose the patient to infection. There is evidence that
some immunocompromised patients with total joint replacements may be at higher
risk for hematogenous infections. However, patients with pins, plates and
screws, or other orthopaedic hardware that is not within a synovial joint are
not at increased risk for hematogenous seeding by microorganisms...
...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 replacement patients prior to any invasive
procedure that may cause bacteremia.
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