Tuesday, July 17, 2012

A case of an infected total hip arthroplasty following a dental procedure.

Hematogenous Infection of Total Hip Arthroplasty With Actinomyces Following a Noninvasive Dental Procedure

Matthew L. Brown, BA; Christopher J. Drinkwater, MD, FRACS

  • Orthopedics
  • July 2012 - Volume 35 · Issue 7: e1086-e1089
  • DOI: 10.3928/01477447-20120621-27

Abstract

This article describes a case of an infected total hip arthroplasty following a dental procedure. A 59-year-old man underwent total hip arthroplasty for osteoarthritis and had a routine recovery. Approximately 9 months postoperatively, he underwent a dental cleaning without antibiotic prophylaxis. One month later, he reported gradually worsening right hip pain and a purulent discharge. After several unsuccessful interventions, the patient was referred to the authors’ facility. The patient’s history, draining sinus tract, and radiographic changes were considered diagnostic of a late chronic infection, and the patient underwent 2-stage revision. Intraoperatively, the sinus tract extended directly to the acetabular component. Actinomyces spp were isolated from 3 of 7 intraoperative anaerobic cultures, and the patient received penicillin G for 8 weeks. Two weeks after discontinuing antibiotics, with no clinical manifestation of recurrent infection and a negative hip aspiration, a new hip prosthesis was implanted. The patient was prescribed penicillin for 12 months postoperatively. Harris Hip Score was 100 at 52-month follow-up.

The American Dental Association and the American Academy of Orthopaedic Surgeons issued consensus guidelines for chemoprophylaxis in orthopedic patients undergoing dental procedures in 1997 and 2003. Although the American Academy of Orthopaedic Surgeons issued a revised guideline in 2009 recommending more robust antibiotic prophylaxis, significant controversy exists because at least one professional organization representing dentists has repudiated the 2009 American Academy of Orthopaedic Surgeons guideline. The authors describe the implications from their experience and similar cases in the literature with regard to such guidelines.

Mr Brown is from the University of Rochester School of Medicine & Dentistry, and Dr Drinkwater is from the Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine & Dentistry, Rochester, New York.
 
Mr Brown and Dr Drinkwater have no relevant financial relationships to disclose.
The authors thank Steven M. Fine, MD, PhD, from the Infectious Disease Division for his contribution to this patient’s care and his interpretation of this patient’s microbiology.
Correspondence should be addressed to: Christopher J. Drinkwater, MD, FRACS, Department of Orthopaedics and Rehabilitation, University of Rochester School of Medicine & Dentistry, 601 Elmwood Ave, Box 665, Rochester, NY 14642 (christopher_drinkwater@urmc.rochester.edu

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Interesting because I have been told my my orthopedic surgeon that I must take antibiotics prior to any dental proceedure for the rest of my life. 

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