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Prosthetic Joint Antibiotic Prophylaxis — MFDS Part 1 MCQ

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ModerateHuman DiseaseProsthetic Joint Antibiotic ProphylaxisMFDS Part 1

A 68-year-old patient had an uncomplicated total hip replacement 18 months ago. They require extraction of an asymptomatic, unrestorable tooth. There is no spreading dental infection, previous prosthetic joint infection, immunocompromise or cardiac indication for infective endocarditis prophylaxis. What is the current UK recommendation?

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Correct answer: C — Proceed without antibiotic prophylaxis solely for the prosthetic joint

The correct answer is C. UK dental guidance states that antimicrobial prophylaxis is not recommended for dental procedures solely because a patient has a joint replacement. Evidence from England has also found no temporal association between invasive dental procedures and subsequent late prosthetic joint infection. The fact that the hip was replaced 18 months ago does not create a two-year prophylaxis indication, so D reflects an outdated time-based approach. Routine pre-operative prophylaxis in B is unsupported, while the postoperative course in C is neither appropriate prophylaxis nor indicated without spreading or systemic infection. A prosthetic joint alone does not necessitate hospital referral, excluding E. Antibiotics may still be required for a separate clinical indication, but none is present here.

Reference: Faculty of General Dental Practice (UK) and Faculty of Dental Surgery, Royal College of Surgeons of England. Antimicrobial Prescribing in Dentistry: Good Practice Guidelines, 3rd edition, section 13.2 Total Joint Replacements, 2020. https://www.rcseng.ac.uk/-/media/Files/RCS/FDS/Publications/FDS-AMP-2020.pdf