Prosthetic Joint No Prophylaxis — ORE Part 1 MCQ

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EasyHuman Disease & Dental ManagementProsthetic Joint No ProphylaxisORE Part 1

A patient had a prosthetic hip joint replacement 3 years ago and requires an invasive dental procedure. They have no cardiac condition associated with infective-endocarditis prophylaxis. What is the appropriate approach to antibiotic prophylaxis?

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Correct answer: E — Do not prescribe it solely for the prosthetic joint

Explanation lettering: D = shown as A · E = shown as D · A = shown as E

A is correct. A prosthetic hip joint alone is not an indication for antibiotic prophylaxis before invasive dental treatment. A large English study using linked hospital and dental data found no temporal association between invasive dental procedures and late prosthetic joint infection, so routine prophylaxis is not justified. UK dental prophylaxis advice concerns prevention of infective endocarditis in patients with specified high-risk cardiac conditions, not orthopaedic joint replacements. B incorrectly applies lifelong routine cover. C invents a postoperative time window unsupported by evidence. D is wrong because diabetes does not create an indication for dental prophylaxis solely in a patient with a prosthetic joint. E is wrong because no prophylactic antibiotic is indicated in this scenario; clindamycin is not prescribed simply because a patient has a joint prosthesis.

Reference: Thornhill MH et al. Analysis of Prosthetic Joint Infections Following Invasive Dental Procedures in England. JAMA Network Open, 2022. https://pubmed.ncbi.nlm.nih.gov/35044470/