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?
9. Can implant factors (i.e. type of bearing) influence the thresholds for serum and synovial markers in acute and chronic PJI?
12. Can short term (two weeks or less) antibiotic treatment be considered following resection arthroplasty for 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?
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?
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?
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?
29. a) 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? b) 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?
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?
42. Does the use of cemented or cementless 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?
44. Does the use of modular femoral neck during primary THA affect the risk of subsequent SSI/PJI?
52. How can hip septic arthritis be differentiated from toxic synovitis?
55. How is PJI diagnosed in the presence of adverse local tissue reaction?
59. In the setting of a dry tap, should lavage with a fluid be performed?
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 enhace the success of this procedure?
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)?
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?
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?
86. Should duration and the type of antibiotic prophylaxis be altered in patients with a prior PJI?
88. Should intra-operative cultures be taken during every revision total joint arthroplasty? If so, how many?
92. Should patients with cellulitis following total joint arthroplasty be treated with antibiotic therapy?
99. Should the duration of antibiotic therapy be altered based on the infecting organism following a single-stage or two-stage exchange arthroplasty?
102. What antibiotic therapy and duration of treatment should be used in Enterococcal PJI?
104. What are surgical alternatives to hip disarticulation?
106. What are the advantages of one-stage exchange arthroplasty?
107. What are the appropriate weight-adjusted prophylactic antibiotic dosages?
110. What are the indications and contraindications for a one-stage exchange arthroplasty for the treatment of chronic PJIs?
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?
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?
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?
125. What is the definition of PJI of the knee and the hip? Can the same criteria be used for both joints?
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?
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?
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. a) What is the optimal length of administration for antibiotic treatment following resection arthroplasty? b) What is the optimal 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?
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?
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?