March 2010 Archives

The American Academy of Orthopaedic Surgeons released an information statement reinforcing the need to take prophylactic antibiotics when having dental work or other invasive procedures.  This recommendation comes from the fact that deep infections of total joint replacements are very costly, both financially and emotionally for the patient due to the need for extensive revision surgery and staged treatment. Patients often do not have normal use of the infected joint until the revision process and surgery is completed, which can be 3-6 months and in some cases longer.  Revision surgery due to infection affects both the patient's quality of life as well as can be a significant financial burden due to time off work.  

Due to the disastrous consequences of infection in a total joint replacement, it is highly recommended to take prophylactic antibiotics.  "It is likely that bacteremia associated with acute infections in the oral cavity, skin, respiratory, gastrointestinal, and urogenital systems and/or other sites can and do cause late implant infections.  Patients with total joint replacements who are having invasive procedures are at an increased risk of hematogenous seeding of their prosthesis."  Therefore, the American Academy of Orthopaedic Surgeons recommends that clinicians consider antibiotic prophylaxis for all total joint replacement patients prior to any invasive procedure that may cause bacteremia.  Invasive procedures include dental cleaning, Orthopaedic, vascular, gastrointestinal, head and neck, obstetric and gynecological, and genitourinary procedures.  The first dose must be given at least 60 minutes before the procedure so that an effective dose is present in the tissues before the procedure begins.  Antibiotic prophylaxis is recommended in most patients, but must be examined on a case-by-case basis.

A population-based case-control study performed revealed that family history of dvt is a risk factor for a first dvt.  Blood samples and information about family history and environmental triggers were collected from 1,605 patients with a first dvt and 2,159 control subjects, 31.5% of patients and 17.3% of the controls reported having one or more first-degree relatives with a history of dvt.  A positive family history increased the risk of dvt more than 2-fold, and up to 4-fold when one or more relatives was affected.  

The risk also increased when a family history of dvt was also present with other genetic or environmental risk factors.  For those with a family history, a genetic, and an environmental risk factor, the risk of dvt was increased 64- fold compared to those without risk factors or a family history.  Overall, it is important to pay attention to a patient's family history of dvt, as it may be beneficial in risk assessment for patients who are undergoing surgery.  Patients who have a family of dvt and are in a hypercoaguable state from surgery, may benefit from extra prophylaxis in the prevention of dvt.