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Perioperative, postoperative, and prophylactic use of antibiotics in alloplastic total temporomandibular joint replacement surgery: a survey and preliminary guidelines.
J Oral Maxillofac Surg 2011; 69(8):2106-11JO

Abstract

PURPOSE

In 2009, the American Academy Of Orthopedic Surgeons recommended lifelong prophylaxis after orthopedic total joint replacement (TJR) before these patients undergo dental, aerodigestive, genitourinary (GU), and gastrointestinal (GI) procedures. Because oral and maxillofacial surgeons worldwide are implanting alloplastic total temporomandibular joint replacements (TMJ TJRs), it appeared reasonable to survey these surgeons to obtain data that might shed some light, not only on this issue, but also to obtain some data to begin to develop preliminary guidelines for the peri- and postoperative use of antibiotics for TMJ TJR using these results and the orthopedic data.

MATERIALS AND METHODS

A total of 35 surgeons worldwide, members of either the TMJ Concepts or Biomet Microfixation online networks were e-mailed a standard questionnaire surveying their perioperative, postoperative, and prophylactic use of antibiotics for their TMJ TJR cases.

RESULTS

Of the 35 surgeons, 26 (74.2%) from 8 different countries responded. A total of 2,476 cases (3,368 joints) were retrospectively surveyed. Of the responding surgeons, 96.2% used, in order of frequency, cefazolin, clindamycin, cephalosporin, or penicillin-based antibiotics in the perioperative period and continued their use for a mean of 7 days (range 5 to 14) postoperatively. Also, 46.2% soaked the TJR components either in the perioperative antibiotic or in vancomycin, poviodine, gentamycin, or peroxide before implantation. In addition, 61.5% irrigated the wounds after device implantation with bacitracin, vancomycin, poviodine, peroxide, or the perioperative antibiotic. These surgeons reported that 51 joints (1.51%) had become infected within a mean of 6 months (range 2 weeks to 12 years) postoperatively. A total of 32 devices (0.95%) required removal and/or replacement. In cases in which the organisms were isolated, the organisms commonly associated with biofilm infection of TJR devices, Staphylococcus aureus, S epidermidis, Peptostreptococcus, and Pseudamonas aeruginosa, were cultured. In only 1 joint (0.003%) was there a suggestion of an association with an invasive dental/aerodigestive, GU/GI procedure. Regarding prophylaxis after TMJ TJRs and before dental/aerodigestive, GU, or GI procedures, 53.8% of the respondents reported that they provided prophylaxis. Of these, 1 recommended doing this for 6 months and 4 for 2 years, such as has been the American Dental Association/American Academy of Orthopedic Surgeons recommendation since 2003; and 9 reported they believe these TMJ TJR patients should have lifetime antibiotic prophylaxis before invasive dental/aerodigestive, GU, or GI procedures.

CONCLUSION

The evidence provided from the present small study survey and a review of the orthopedic data could provide the opportunity to develop guidelines for the preoperative, intraoperative, and postoperative antibiotic management for TMJ TJRs and spur additional research into this important area of patient management.

Authors+Show Affiliations

Clinical Consultant, TMJ Concepts, Ventura, CA, USA. lgm@tmjconcepts.comNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

21470752

Citation

Mercuri, Louis G., and David Psutka. "Perioperative, Postoperative, and Prophylactic Use of Antibiotics in Alloplastic Total Temporomandibular Joint Replacement Surgery: a Survey and Preliminary Guidelines." Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons, vol. 69, no. 8, 2011, pp. 2106-11.
Mercuri LG, Psutka D. Perioperative, postoperative, and prophylactic use of antibiotics in alloplastic total temporomandibular joint replacement surgery: a survey and preliminary guidelines. J Oral Maxillofac Surg. 2011;69(8):2106-11.
Mercuri, L. G., & Psutka, D. (2011). Perioperative, postoperative, and prophylactic use of antibiotics in alloplastic total temporomandibular joint replacement surgery: a survey and preliminary guidelines. Journal of Oral and Maxillofacial Surgery : Official Journal of the American Association of Oral and Maxillofacial Surgeons, 69(8), pp. 2106-11. doi:10.1016/j.joms.2011.01.006.
Mercuri LG, Psutka D. Perioperative, Postoperative, and Prophylactic Use of Antibiotics in Alloplastic Total Temporomandibular Joint Replacement Surgery: a Survey and Preliminary Guidelines. J Oral Maxillofac Surg. 2011;69(8):2106-11. PubMed PMID: 21470752.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Perioperative, postoperative, and prophylactic use of antibiotics in alloplastic total temporomandibular joint replacement surgery: a survey and preliminary guidelines. AU - Mercuri,Louis G, AU - Psutka,David, Y1 - 2011/04/05/ PY - 2010/06/30/received PY - 2011/01/04/accepted PY - 2011/4/8/entrez PY - 2011/4/8/pubmed PY - 2011/9/29/medline SP - 2106 EP - 11 JF - Journal of oral and maxillofacial surgery : official journal of the American Association of Oral and Maxillofacial Surgeons JO - J. Oral Maxillofac. Surg. VL - 69 IS - 8 N2 - PURPOSE: In 2009, the American Academy Of Orthopedic Surgeons recommended lifelong prophylaxis after orthopedic total joint replacement (TJR) before these patients undergo dental, aerodigestive, genitourinary (GU), and gastrointestinal (GI) procedures. Because oral and maxillofacial surgeons worldwide are implanting alloplastic total temporomandibular joint replacements (TMJ TJRs), it appeared reasonable to survey these surgeons to obtain data that might shed some light, not only on this issue, but also to obtain some data to begin to develop preliminary guidelines for the peri- and postoperative use of antibiotics for TMJ TJR using these results and the orthopedic data. MATERIALS AND METHODS: A total of 35 surgeons worldwide, members of either the TMJ Concepts or Biomet Microfixation online networks were e-mailed a standard questionnaire surveying their perioperative, postoperative, and prophylactic use of antibiotics for their TMJ TJR cases. RESULTS: Of the 35 surgeons, 26 (74.2%) from 8 different countries responded. A total of 2,476 cases (3,368 joints) were retrospectively surveyed. Of the responding surgeons, 96.2% used, in order of frequency, cefazolin, clindamycin, cephalosporin, or penicillin-based antibiotics in the perioperative period and continued their use for a mean of 7 days (range 5 to 14) postoperatively. Also, 46.2% soaked the TJR components either in the perioperative antibiotic or in vancomycin, poviodine, gentamycin, or peroxide before implantation. In addition, 61.5% irrigated the wounds after device implantation with bacitracin, vancomycin, poviodine, peroxide, or the perioperative antibiotic. These surgeons reported that 51 joints (1.51%) had become infected within a mean of 6 months (range 2 weeks to 12 years) postoperatively. A total of 32 devices (0.95%) required removal and/or replacement. In cases in which the organisms were isolated, the organisms commonly associated with biofilm infection of TJR devices, Staphylococcus aureus, S epidermidis, Peptostreptococcus, and Pseudamonas aeruginosa, were cultured. In only 1 joint (0.003%) was there a suggestion of an association with an invasive dental/aerodigestive, GU/GI procedure. Regarding prophylaxis after TMJ TJRs and before dental/aerodigestive, GU, or GI procedures, 53.8% of the respondents reported that they provided prophylaxis. Of these, 1 recommended doing this for 6 months and 4 for 2 years, such as has been the American Dental Association/American Academy of Orthopedic Surgeons recommendation since 2003; and 9 reported they believe these TMJ TJR patients should have lifetime antibiotic prophylaxis before invasive dental/aerodigestive, GU, or GI procedures. CONCLUSION: The evidence provided from the present small study survey and a review of the orthopedic data could provide the opportunity to develop guidelines for the preoperative, intraoperative, and postoperative antibiotic management for TMJ TJRs and spur additional research into this important area of patient management. SN - 1531-5053 UR - https://www.unboundmedicine.com/medline/citation/21470752/Perioperative_postoperative_and_prophylactic_use_of_antibiotics_in_alloplastic_total_temporomandibular_joint_replacement_surgery:_a_survey_and_preliminary_guidelines_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0278-2391(11)00061-9 DB - PRIME DP - Unbound Medicine ER -