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(Accepted 27January 1986)

The need for antimicrobial prophylaxis for patients with major joint prostheses has not been established. This question has been examined in the United States where an estimated 120 000 hip or knee replacements were carried out in 1976 and in increasing numbers since then. Most haematogenous infections of prosthetic joints appear to have been secondary to acute or chronic foci ofinfection elsewhere in the body but, unexpectedly perhaps, not in relation to dental treatment. There appear to be only nine reported cases of infection of such joints attributed to dental bacteraemias but in none of these cases were the bacteria of a type likely to have originated from the mouth. Most infections were staphylococcal and none was caused by viridans streptococci (the main bacteria found in the blood after dental operations). This finding indicates that the regimens suggested for the prophylaxis ofinfective endocarditis in dental patients would be inappropriate for dental patients with joint replacements.

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