AAOS Updates Appropriate Use Criteria on Prevention of Implant Infection in Patients Undergoing Dental Procedures

At its June meeting, the AAOS Board of Directors approved the updated Appropriate Use Criteria (AUC) for the Prevention of Orthopaedic Implant Infection in Patients Undergoing Dental Procedures, replacing the previous 2016 version. This new AUC is informed by the most current evidence from the 2024 AAOS Clinical Practice Guideline on the Prevention of Periprosthetic Joint Infection in Patients Undergoing Dental Procedures following Total Hip and Knee Arthroplasty. The AUC writing and rating panels included representatives of not only AAOS but also the American Dental Association, the Infectious Diseases Society of America, the Musculoskeletal Infection Society, the American Association of Hip and Knee Surgeons, the Knee Society, and the Hip Society.

The newly developed AUC is designed to assess the appropriateness of antibiotic prophylaxis for reducing the theoretical risk of postoperative prosthetic joint infection (PJI) in lower-risk patients undergoing dental procedures. Currently, there are no data to guide clinical decisions for a small subset of higher-risk patients—such as those with revision implants, mega-prostheses, compromised soft-tissue coverage, or a history of PJI.

To support clinical decision making, the AUC online tool provides guidance based on two patient indicators:

1. Level of invasiveness of the dental procedure: Further details for both procedure types are outlined in the AUC assumptions section, accessible prior to use of the online tool.
   • noninvasive: procedures that do not involve manipulation of gingival or periapical tissue or perforation of the oral mucosa
   • invasive: procedures that do involve manipulation of gingival tissue, the periapical region of the teeth, or perforation of the oral mucosa
2. Systemic host status: immunocompetent or immunocompromised

Once the clinician submits the relevant patient indication profile, the AUC tool generates procedure recommendations using a simple visual system:

• A green checkmark indicates a treatment is appropriate.
• A yellow caution symbol signifies a treatment that may be appropriate.
• A red X denotes a treatment that is rarely appropriate.

For this AUC, the procedure recommendation options are:

• Prescribe patient-appropriate antibiotics. (Clinicians are prompted to review specific definitions related to immunocompromised status.)
• Do not prescribe antibiotics.

The AUC, as well as 26 additional AUC spanning various orthopaedic topics, are available at OrthoGuidelines via either the website or the free mobile app. Visit orthoguidelines.org to get started.