DOCUMENTS | ICMORTHO

Sh58: What is the role of IV vs oral antibiotics in the treatment of acute shoulder PJI? Does the treatment change based on the diagnostic criteria (Definite vs Probable vs Possible)?

Sh59: What is the role of IV vs oral antibiotics in the treatment of late shoulder PJI? Does the treatment change based on the diagnostic criteria (Definite vs Probable vs Possible)?

Sh60: Should bacterial virulence determine antibiotic treatment?

Sh61: What is the optimal timing of second stage revision surgery in the treatment of PJI? Is this dependent on organism?

Sh62: What are the optimal oral or IV antibiotics to be used based on the most common bacteria cultured?:

Sh63: What is the optimal oral abx for chronic suppression?

Sh64: What is the optimal oral or IV antibiotic treatment in cases of culture negatve PJI?

Sh65: What is the role and benefit of multiple spacers in the setting of 2 stage with persistent positive culture:

Sh66: What is the optimal surgical protocol for performing DAIR in patients with acute PJI?

Sh67: During single stage exchange arthroplasty, should we use two separate instrument set-ups and redrape after resection?

Sh68: What type of spacer works best for elution of antibiotics? does off-the shelf spacer versus custom antibiotic-tailored spacer affect outcomes?

Sh69: Can material (cement, metal, plastic, etc) be retained in the setting of one or 2 stage debridement without impact on final recurrence?

Sh70: Is there a role for a functional (metal-based) antibiotic cement spacer in treating shoulder PJI?

Sh71: What are optimal antibiotics to be added to an antibiotic-loaded cement spacer for treating shoulder PJI?

Sh72: What is the role of topical intrawound antiseptics (dilute betadine lavage, acetic acid, chlorhexidine, hydrogen peroxide.or antibiotics added to the irrigation solution) to treat shoulder PJI?

Sh73: During protracted revision arthroplasty surgery, should a second dose of prophylactic antibiotics be given during the course of surgery and if so, when? If applicable, should the administration of a second dose be based on the duration of the surgery, blood loss, magnitude of revision (size of implant) or other factors?

Sh74: Is there any evidence that adding antibiotics to cements negatively impacts on the integrity of the cement?

Sh75: What are the recommendations for the route (IV versus PO) and duration of postoperative antibiotic treatment when a one-stage revision arthroplasty is performed for subacute or chronic shoulder PJI of the shoulder caused by an indolent organism (e.g. C. acnes or Coagulase Negative Staphylococcus)?

Sh76: What are the recommendations regarding the route (IV versus PO) and length of postoperative antibiotic treatment when a one-stage revision arthroplasty is performed for subacute/chronic shoulder PJI caused by a virulent organism (e.g. MRSA, MSSA, E. coli)?

Sh77: Should bone graft or cement be removed during treatment of acute shoulder PJI?

Sh78: Should bone graft or cement be removed in treatment for subacute or chronic shoulder PJI?

Sh79: Is there a role for irrigation and debridement with implant retention when treating acute shoulder PJI?

Sh80: What are the indications for irrigation and debridement with component retention in subacute or chronic shoulder PJI?

Sh81: Should modular components be exchanged during irrigation and debridement of subacute or chronic shoulder PJI?

Sh82: Should well-fixed glenoid components be removed during surgical treatment for subacute or chronic shoulder PJI?

Sh83: Is there a role for routine exchange of all well-fixed implants in revision shoulder arthroplasty without clinical or radiographic signs of infection?

Sh84: What are the indications for one versus two-stage exchange arthroplasty in the management of acute shoulder PJI?

Sh85: What are the indications for one versus two stage revision in subacute or chronic shoulder PJI?

Sh86: What is the treatment (if any) for unexpected positive cultures (UPC) in revision shoulder arthroplasty without clinical or radiographic signs of infection?

Sh1: Is there evidence for sex/gender specific approaches to prevention of PJI?

Sh2: Is there a role for prolonged peri-operative antibiotics to prevent acute post-operative PJI?

Sh3: What is the appropriate management of disease modify drugs (DMARDs, kinase inhibitors, etc) in the perioperative period?

Sh4: Is testosterone supplementation associated with increased risk of shoulder PJI?

Sh5: Should testosterone supplementation be stopped prior to for a period of time after arthroplasty? If so, when should it be restarted?

Sh6: How does surgical time influence risk of PJI?

Sh7: How shoulder antibiotics be managed in outpatient shoulder arthroplasty?

Sh8: Is bone-grafting associated with higher rate of PJI when compared to metal reconstruction in revision surgery?

Sh9: Does the use of pyrocarbon prevent shoulder PJI?

Sh10: Are markers of poor nutrition associated with PJI (Vitamin D, albumin, prealbumin, transferrin, etc)

Sh11: Is there efficacy of antibiotic powder during skin closure on PJI prevention?

Sh12: What is the association between hgb a1c and shoulder PJI?

Sh13: Should a bovie be used for skin incision?

Sh14: Should iodine impregnated drapes be used?

Sh15: Should hair be clipped from the shoulder?

Sh16: What is the role of topical intrawound antiseptics (dilute betadine lavage, acetic acid, chlorhexidine, hydrogen peroxide.or antibiotics added to the irrigation solution) during primary or revision shoulder arthroplasty?

Sh17: What is the role of tranexamic acid (TXA) during primary or revision shoulder arthroplasty in decreasing the risk of PJI?

Sh18: Does prior corticosteroid injection increase the risk of PJI after primary or revision shoulder arthroplasty?

Sh19: What is the best presurgical skin preparation in the operating room? (antiseptic solutions, concentrations, order of use)

Sh20: Is it necessary for patients to use home-based skin cleansers prior to surgery? If so, what is the best?

Sh21: What are the optimal peri-operative antibiotics for primary shoulder arthroplasty? What if allergic to cefazolin?

Sh22: Does the type of shoulder arthroplasty affect the rate of acute post-operative PJI?

Sh23: Does the diagnostic indication for shoulder arthroplasty affect the rate of acute post-operative PJI?

Sh24: Should anti-platelet medications (aspirin/clopidogrel) be discontinued prior to revision arthroplasty surgery? If, on medical grounds, it is continued, does its continued use result in greater complication rates, and in particular higher rates of PJI?

Sh25: What is the role for dental prophylaxis after shoulder replacement? Should other invasive procedures be prophylaxed (Colonoscopy, cystoscopy, etc)?

Sp13: In patients with inconclusive biopsy, can empirical therapeutic trial with anti-tuberculosis drugs be initiated or repeat biopsy is necessary?

Sp14: Management of a patient not responding clinically to anti-tubercular therapy - Should second line drugs be started or a repeat biopsy needed to confirm resistance to primary drugs?

Sp15: How long should drug therapy be given in patients responding well to anti-tubercular medications?

Sp16: Is there a value of neo-adjuvant chemotherapy for spinal tuberculosis in patients planned for surgery?

Sp17: If the patient has stopped drug therapy during the course of treatment for more than a month, should the drug therapy be restarted and continued as for a new patient?

Sp18: What is the best method of assessment of response (clinical/ serological/ radiological) to conservative treatment in spinal tuberculosis?

Sp19: Is it possible to predict the final deformity in spinal tuberculosis in patients undergoing conservative treatment?

Sp20: Is there any need for strict bed rest during conservative therapy and what are the indications for ambulatory chemotherapy?

Sp21: Does the use of braces help in reducing pain, deformity and collapse in conservative therapy?

Sp22: What are the radiological parameters for reliably describing instability and the value of instability scores for planning surgical stabilisation in spinal tuberculosis?

Sp23: What are the indications for surgical intervention in terms of neurological deficit in spinal tuberculosis?

Sp24: Is it safe to add steroids in a patient with neurological deficit planned for conservative drug therapy?

Sp25: During follow up, to assess radiological healing, is MRI alone enough or a plain radiograph and CT scan also necessary and How often should radiological investigations be done to confirm healing in spinal tuberculosis?

Sp26: In a patient showing good clinical response, is MRI evidence of delayed or non-healing an indication for surgery?

Sp27: Are there differences in the natural history of spinal tuberculosis between children, adults and the elderly?

Sp28: In a spinal tuberculosis patient with neurological deficit, how long can we wait for response with drug therapy before deciding for surgery?

Sp29: Do all psoas abscesses need to be drained? What are the indications for CT guided drainage, pig–tail catheter or open drainage of psoas abscess?

Sp30: Is there a difference in the duration of drug therapy between patients who are conservatively treated and those who undergo surgical debridement and stabilisation?

Sp31: Is there a role for only decompression and debridement of infection focus by endoscopic or transpedicular approaches in spinal tuberculosis?

Sp32: In the present age of ‘posterior only’ surgeries, when is anterior surgery required in spinal tuberculosis?

Sp33: How much of pre-treatment local kyphosis can be accepted and what level of kyphosis is an indication for spinal fixation and reconstruction?

Sp34: In posterior only approach, what are the indications for only spinal stabilisation; spinal stabilisation with spinal column shortening; and spinal stabilisation with anterior reconstruction?

Sp35: In anterior column reconstruction, is there a preference in the usage of various Bone grafts like ribs, fibula, or iliac crest/ and when is titanium cage preferred?

Sp36: In Patient undergoing surgery for correction of healed post TB spinal kyphosis, is there a need to give preoperative ATT to prevent recurrence of the disease?

Sp37: Can albumin or pre-albumin, as markers of patient malnourishment, predict outcomes in patients with pyogenic spinal infections?