2. Are there any contraindications to knee or hip aspiration prior to revision surgery?
3. Are there any tests that can guide antimicrobial treatment in patients with PJI and allow stopping these agents?
4. Are there significant differences in the yield of culture between pre-operative aspiration and intra-operative culture samples? If so, which result should be utilized?
6. Can debridement, antibiotics, and implant retention be used to treat acute fungal PJI?
7. Can debridement, antibiotics, and implant retention be utilized in patients with a unicondylar knee arthroplasty (UKA) acute or chronic PJI?
8. Can debridement, implant retention, and antibiotic be utilized in the treatment of acute PJI with a megaprosthesis?
9. Can implant factors (i.e. type of bearing) influence the thresholds for serum and synovial markers in acute and chronic PJI?
10. Can intra-operative or post-operative blood salvage be utilized in patients undergoing reimplantation for treatment of PJI?
11. Can PJI be assigned a high or low grade? If so, what is the definition of each grade?
12. Can short term (two weeks or less) antibiotic treatment be considered following resection arthroplasty for chronic PJI?
13. Can sub-radical resection arthroplasty (leaving parts of implants in place) be considered during management of patients with chronic PJI?
14. Do all metallic implants need to be removed to eradicate PJI? Does this apply to other metal hardware present (e.g. hook plates, cables) too?
15. Do bone cultures provide additional diagnostic accuracy in the diagnosis of PJI?
16. Do immunomodulatory disease-modifying medications (e.g. methotrexate, anti-TNF agents) need to be withheld pre-operatively to reduce the risk for subsequent SSI/PJI?
17. Do patients undergoing outpatient total joint arthroplasty have a higher incidence of SSI/PJI?
18. Do patients with adverse local tissue reaction (ALTR) have a higher incidence of PJI?
19. Does an animal model for PJI exist?
20. Does arthroscopic surgery have any role in the treatment of acute or chronic PJI of the knee or the hip?
21. Does arthroscopy have a role in management of patients with hip and knee PJI?
22. Does changing the drapes during debridement, antibiotic, and implant retention affect the rate of success?
23. Does exchange of all modular components during debridement, antibiotic, and implant retention (DAIR) reduce the rate of SSI/PJI recurrence?
24. Does extended oral antibiotic prophylaxis following reimplantation reduce the risk of future failure? If so, how long and what type of antibiotic should be administered?
25. Does extended prophylactic antibiotics therapy for patients undergoing aseptic revision help reduce the risk of subsequent SSI/PJI?
26. Does identification of the pathogen prior to performing debridement, antibiotics and implant retention (DAIR) help guide the surgeon's decision making? If so, should you wait in a clinically stable patient until the pathogen has been identified?
27. Does performing a debridement, antibiotics, and implant retention affect the outcome of a subsequent two-stage exchange arthroplasty?
28. Does performing a primary total joint arthroplasty after a dirty case (infection or open abdomen) in the same operating room increase the risk of SSI/PJI?
29. Does prior septic arthritis (aerobic, anaerobic, fungal, tuberculosis) of a native joint predispose the patients to an increased risk of subsequent PJI in the same joint receiving arthroplasty? If yes, how long after a prior septic arthritis can elective arthroplasty be performed in the same joint?
30. Does routine use of a new set of surgical instruments and equipment following debridement and before implantation reduce the risk of SSI/PJI recurrence? Is it necessary to change all surgical fields before the final reimplantation in septic revision surgery?
31. Does simultaneous bilateral hip or knee arthroplasty increase the risk of subsequent SSI/PJI compared to unilateral or staged bilateral arthroplasty?
32. Does the morbidity and mortality differ between single-stage and two-stage exchange arthroplasty?
33. Does the presence of both an ESR and CRP below the PJI thresholds rule out the diagnosis of PJI?
34. Does the surface (grit blasted, plasma sprayed, porous metal, porous beaded, HA coated) of uncemented THA components influence the rate of subsequent SSI/PJI?
35. Does the surgical approach (parapatellar vs subvastus) during primary TKA affect the incidence of subsequent SSI/PJI?
36. Does the surgical approach of primary THA affect the incidence of subsequent SSI/PJI?
37. Does the type of bearing surface influence the incidence of SSI/PJI after total hip arthroplasty?
38. Does the type of fixation of an arthroplasty component influence the incidence of subsequent SSI/PJI?
39. Does the type of infective organism in orthopedic infections alter the recommended duration of antibiotic therapy (Does the MSIS Consensus agree with the IDSA guideline)?
40. Does the use of a tourniquet influence the rate of SSI/PJI in primary or revision TKA?
41. Does the use of allografts alter the recommended duration of prophylactic antibiotics?
42. Does the use of cemented or uncemented components at the time of reimplantation affect the success of treating chronic PJI? If yes, what is the optimal antibiotic(s), dosage, and cement to maximize antibiotic delivery and mechanical properties of the cement during reimplantation of a two-stage procedure for PJI?
43. Does the use of drains reduce the effectiveness of antibiotic-impregnated cement spacers?
44. Does the use of modular femoral neck during primary THA affect the risk of subsequent SSI/PJI?
45. Does the use of non-antibiotic impregnated allograft for bone defects during reimplantation increase the risk of recurrence of SSI/PJI?
46. Does the use of peri-articular injections affect the rate of SSI/PJI recurrence in reimplantation?
47. Does the use of personal protection suits (space suits) influence the rate of SSI/PJI in patients undergoing arthroplasty?
48. Does the use of separate instruments for each side reduce the rate of subsequent SSI/PJI in patients undergoing simultaneous bilateral hip or knee arthroplasties?
49. Does the use of sterile surgical vests decrease the risk of contamination or incidence of infection following total joint arthroplasty?
50. Does the use of tantalum augments during a single-stage revision for PJI influence the rate of subsequent SSI/PJI?
51. Does the virulence (low or high) of the infecting organism affect the treatment of acute hematogenous or chronic PJI?
52. How can hip septic arthritis be differentiated from toxic synovitis?
53. How can superficial SSI be differentiated from PJI?
54. How does the duration from surgery change the reliability of synovial analysis in terms of leucocyte count and percentage of neutrophil granulocytes?
55. How is PJI diagnosed in the presence of adverse local tissue reaction?
56. How many debridement, antibiotics, and implant retention procedure(s) is/are acceptable before resection arthroplasty needs to be performed?
57. How many exchange arthroplasties are reasonable before a salvage operation (such as amputation or arthrodesis) should be considered?
59. In the setting of a dry tap, should lavage with a fluid be performed?
60. Is aseptic loosening associated with an undiagnosed PJI?
61. Is debridement, antibiotic, and implant retention (DAIR) an emergency procedure for patients with acute PJI or should optimization be implemented prior to surgery to enhance the success of this procedure ?
62. Is it necessary to revise or reduce dislocated articulating antibiotic spacers?
63. Is it possible to have an isolated infection of only a portion of the joint (for example the femur and not the acetabulum or tibia and not the femur)?
64. Is it safe to retain a stable cement mantle, for later use, in patients undergoing resection arthroplasty for PJI?
66. Is the diagnosis of post-traumatic arthritis associated with an increased risk of subsequent SSI/PJI after arthroplasty?
67. Is the persistent elevation of inflammatory markers after resection arthroplasty and completion of antibiotic therapy a contra-indication to reimplantation?
68. Is the use of highly porous tantalum associated with a risk of SSI/PJI recurrence in revision total joint arthroplasty?
69. Is there a concern for contamination of the surgical field by particles, such as cement, that may escape the wound intraoperative by coming into contact with the ceiling light or facial masks and fall back into the wound?
70. Is there a difference in outcome and survival between arthrodesis and above-knee amputation for chronic knee PJI?
71. Is there a difference in the organism profile that causes PJI in different countries?
73. Is there a minimum number of PJI procedures a surgeon should perform annually that qualifies them as experts in management of PJI?
74. Is there a role for administration of prolonged oral antibiotics following primary total joint arthroplasty?
75. Is there a role for direct intra-articular antibiotic infusion following irrigation and debridement for PJI?
77. Is there a role for non-antibiotic antiseptic agents (e.g. honey, vinegar, local anesthetics) as an irrigation solution during surgical debridement for PJI?
78. Is there a role for obtaining cultures before and after prosthesis implantation during revision total joint arthroplasty?
79. Is there a role for single-stage exchange arthroplasty in acute PJI of cement less THA?
80. Is there a role for sonication of implants retrieved during explanation?
81. Is there difference in the type of pathogens that can cause SSI/PJI between hip and knee arthroplasty?
82. Is there is a benefit for the engagement of a multidisciplinary team for the management of patients with PJI?
84. Is undergoing a colonoscopy or upper GI endoscopy after total joint arthroplasty associated with an increased risk of SSI/PJI? If yes, does antibiotic prophylaxis prior to a colonoscopy or upper GI endoscopy after total joint arthroplasty reduce the risk of SSI/PJI?
85. Should all knee compartments be resected during resection of an infected unicondylar knee arthroplasty (UKA)?
86. Should duration and the type of antibiotic prophylaxis be altered in patients with a prior PJI?
87. Should heterotopic ossification be removed during resection arthroplasty of an infected prosthetic joint?
88. Should intra-operative cultures be taken during every revision total joint arthroplasty? If so, how many?
89. Should intraoperative purulence be considered as a definitive sign of PJI?
90. Should operative treatment differ in patients with systemic sepsis in the setting of PJI?
91. Should patients undergoing outpatient total joint arthroplasty receive additional post-operative prophylactic antibiotics?
92. Should patients with cellulitis following total joint arthroplasty be treated with antibiotic therapy?
94. Should patients with PJI caused by Mycobacterium tuberculosis undergo the typical two-week drug holiday prior to reimplantation?
95. Should prophylactic antibiotic therapy be administered for an extended duration in patients admitted to the ICU?
97. Should surgeons make effort to remove cement that has extruded into pelvis or difficult anatomical position in patients with PJI?
98. Should the antibiotics placed in a cement spacer be tailored to the sensitivity of the infective organism?
99. Should the duration of antibiotic therapy be altered based on the infecting organism following a single-stage or two-stage exchange arthroplasty?
100. Should we routinely assess for metal levels when working up a painful total joint?
101. What antibiotic therapy (agent, route, dose and duration) is recommended for Gram-negative acute PJI being treated with debridement, antibiotics, and implant retention?
102. What antibiotic therapy and duration of treatment should be used in Enterococcal PJI?
103. What antifungals, route of administration, and duration of treatment should be utilized to treat fungal PJI?
104. What are surgical alternatives to hip disarticulation?
105. What are the absolute and relative contraindications to elective primary total joint arthroplasty, with respect to SSI and PJI risk?
106. What are the advantages of one-stage exchange arthroplasty?
107. What are the appropriate weight-adjusted prophylactic antibiotic dosages?
108. What are the contraindications to using antibiotics in a cement spacer?
109. What are the diagnostic accuracy of histologic tests and thresholds used in the diagnosis of PJI?
110. What are the indications and contraindications for a one-stage exchange arthroplasty for the treatment of chronic PJIs?
111. What are the indications and contraindications of using debridement, antibiotics, and implant retention with modular components for the management of PJI?
113. What are the indications for the use of non-articulating (vs articulating) spacers during resection arthroplasty of the hip or knee?
114. What are the indications for utilizing Fosfomycin, Tigecycline and Daptomycin, either instead of other antibiotics or in conjunction with other antibiotics for the management of PJI?
115. What are the radiological signs indicative of infection in patients with an arthroplasty component in place?
116. What are the treatment options for infected bilateral hip or knee arthroplasties?
117. What can be done with a prosthesis that has been dropped on the floor or allowed to come into contact with a non-sterile portion of the operating room?
118. What clinical findings (e.g. fever, erythema, reduced ROM) are most sensitive and specific for the diagnosis of PJI?
120. What imaging modalities are available to help evaluate the extent of an infection and guide bone resection?
121. What indicators/metrics would compel a surgeon to perform resection arthroplasty and antibiotic spacer insertion, delaying the arthroplasty to a later date, in a patient with prior septic arthritis undergoing primary arthroplasty?
122. What infectious screening should all patients undergo prior to hip or knee aseptic revision?
123. What intra-operative metrics can be utilized at time of intended reimplantation to help decision-making and reduce the risk of subsequent recurrence?
124. What is an acceptable sensitivity, specificity, negative predictive value, and positive predictive value for a diagnostic tool for PJI?
125. What is the definition of PJI of the knee and the hip? Can the same criteria be used for both joints?
126. What is the definition of septic arthritis in a native knee?
127. What is the definition of success of surgical treatment of a patient with PJI? What clinical, operative, microbiological and functional metrics should be considered?
129. What is the diagnostic accuracy of an aspiration of a cement spacer following a drug-holiday? Should it routinely be performed prior to reimplantation?
130. What is the diagnostic accuracy of frozen section during reimplantation surgery? What thresholds should be used in this context?
131. What is the incidence of culture-negative infections and what are the diagnostic protocols for further investigating these cases?
132. What is the minimum necessary volume of irrigation solution to use in debridement, antibiotics, and implant retention treatment of acute PJI?
133. What is the most effective combination of antibiotics in the treatment of acute PJI caused by MRSA that has undergone surgical management with debridement, antibiotics, and implant retention?
134. What is the optimal antibiotic therapy in cases of culture-negative PJI?
135. What is the optimal antibiotic(s) dosage to be used in cement during reimplantation that does not significantly interfere with mechanical strength of cement used for fixation?
136. What is the optimal follow-up plan (schedule, exam maneuvers, labs, imaging) for patients being treated for PJI? How frequently should the inflammatory biomarkers be measured after the resection arthroplasty performed as part of two-stage exchange?
137. What is the optimal length and mode of administration for antibiotic treatment following resection arthroplasty?
138. What is the optimal length of antibiotic treatment following debridement, antibiotics, and implant retention for acute PJI?
141. What is the recommended duration of antibiotics after a single-stage exchange for PJI?
142. What is the role of alpha-defensin in the diagnosis of PJI?
143. What is the role of nuclear imaging (PET scan, Leukocyte labeled, etc.) in diagnosing PJI?
144. What is the role of oral suppression antibiotics after reimplantation in patients with negative cultures after 14 days of incubation?
145. What is the role of Specific Granulocyte Counting Methods and New Immunohistologic Staining Techniques in diagnosing PJI?
146. What is the utility of a two-week antibiotic holiday prior to reimplantation?
147. What nutritional markers are the most sensitive and specific for SSI/PJI? Does improvement in nutritional status reduce the risk of SSI/PJI?
148. What products can be applied to an implant surface to prevent or treat SSI/PJI?
149. What should be done for patients with persistent wound drainage after total joint arthroplasty? What are the indications for surgical intervention?
150. What tools (i.e. KLIC score) are available to help predict successful treatment with debridement, antibiotics, and implant retention? What are the accuracy of these tools?
151. When a patient undergoes aseptic revision and intra-operative culture(s) grow an organism, should patients be treated with antibiotic therapy? If so, what is the recommended route and duration of antibiotic therapy?
152. When is the optimal time to change IV antibiotic(s) to an oral agent(s) after a resection arthroplasty as part of two-stage exchange?
153. When should rifampin be added to the regimen of antibiotics for management of patients with PJI undergoing surgical treatment?
154. When soft tissue coverage requires a reconstructive flap, can it be performed at the time of explant or should it be deferred until reimplantation?
155. Which antibiotic(s) should be added to a cement spacer in patients with PJI caused by multi-resistant organisms?
156. Which patients should be considered for administration of long-term suppressive oral antibiotic instead of surgical treatment in patients with chronic PJI?
157. Does antibiotic-impregnated cement could reduce the incidence of PJI following elective primary total hip arthroplasty? Does antibiotic-impregnated cement could reduce the incidence of PJI following elective primary total knee arthroplasty?
158. Does antibiotic impregnated cement reduces the incidence of PJI following elective revision hip arthroplasty? Does antibiotic impregnated cement reduces the incidence of PJI following elective revision hip arthroplasty?