LAUSR

American Dental Association– Appointed Members of the Expert Writing and Voting Panels Contributing to the Development of American Academy of Orthopedic Surgeons Appropriate Use Criteria A pproximately 332,000 primary total hip arthroplasties and 719,000 primary total knee arthroplasties were performed in the United States in 2010; 96% of hip replacement and 98% of knee replacement surgeries were performed on patients 45 years and older. Reported infection rates for such operations range from 0.8% to 2.2%. Infections can be caused by introduction of microorganisms at the time of surgery, hematogenous seeding, or contiguous spread of infection from an adjacent site. Infections of total joint replacements can result in failure of the initial surgical procedure and the need for extensive revision, prolonged antibiotic treatment, functional impairment, considerable cost of care, and even death. In 2014, the American Dental Association (ADA) Council on Scientific Affairs (CSA) assembled an expert panel to update and clarify the clinical recommendations found in a 2012 joint ADA and American Academy of Orthopaedic Surgeons (AAOS) evidence report and guideline. In accord with the 2012 ADA/AAOS evidence report, the updated ADA systematic review (published in the January 2015 issue of The Journal of the American Dental Association) found no statistically significant association between dental procedures and prosthetic joint infections (PJI). On the basis of the review of the evidence, the 2015 ADA Clinical Practice Guideline stated, “In general, for patients with prosthetic joint implants, prophylactic antibiotics are not recommended prior to dental procedures to prevent prosthetic joint infection.” The ADA panel found no association between dental procedures and PJIs and no scientifically based efficacy for using antibiotics to prevent PJIs. The panel did acknowledge that there may be special circumstances in which a clinician may consider antibiotic prophylaxis despite the lack