Reimplantation

• Question 1: Are the MSIS/ICM criteria valid for decision-making before reimplantation?

• Question 2: What metrics should be considered to determine the timing of reimplantation after two-stage exchange arthroplasty of the infected hip or knee?

• Question 3: Is normalization of serological markers necessary prior to reimplantation arthroplasty performed as part of a 2-stage exchange?

• Question 4: What is the importance of two-week antibiotic holiday prior to reimplantation?

• Question 5: What is the diagnostic accuracy of joint aspiration of a cement spacer in conjunction with clinical evaluation, imaging, serologic tests, and biopsies? Should it routinely be performed prior to reimplantation?

• Question 6: What intra-operative metrics can be utilized at the time of intended reimplantation to help decision-making and reduce the risk of subsequent recurrence?

• Question 7: What is the diagnostic accuracy of frozen section during reimplantation surgery? What thresholds should be used in this context?

• Question 8: Should patients with periprosthetic joint infections (PJIs) caused by Mycobacterium tuberculosis undergo the typical two-week antimicrobial holiday prior to reimplantation?

Pathogen Factors

• Question 1: Does the virulence (low or high) of the infecting organism affect the treatment of acute hematogenous or chronic periprosthetic joint infections (PJIs)?

• Question 2: Is there a difference in the treatment outcome for periprosthetic joint infections (PJIs) caused by a single organism and a polymicrobial PJI?

• Question 3: Is there a difference in the type of pathogens that can cause SSIs/PJIs between hip and knee arthroplasty?

• Question 4: Is there a difference in the organism profile that causes periprosthetic joint infections (PJIs) in different countries?

Fungal PJI

Diagnosis and Treatment

• Question 1: What is the optimal method to diagnose fungal PJI?

• Question 2: Should patients with periprosthetic joint infections (PJIs) caused by a fungus undergo the typical two-week antimicrobial holiday prior to reimplantation?

• Question 3: Can debridement, antibiotics, and implant retention be used to treat acute fungal periprosthetic joint infections (PJIs)?

• Question 4: Which antifungals, route of administration, and duration of treatment should be utilized to treat fungal periprosthetic joint infections (PJIs)?

Treatment

Algorithm

• Question 1: Is there a role for administration of prolonged oral antibiotics following primary total joint arthroplasty?

• Question 2: What is the role of oral suppression antibiotics after reimplantation in patients with negative cultures after 14 days of incubation?

• Question 3: Which patients should be considered for administration of longterm suppressive oral antibiotic instead of surgical treatment in patients with chronic periprosthetic joint infections (PJIs)?

Outcomes

• Question 1: What is the definition of success of surgical treatment of a patient with a periprosthetic joint infection (PJI)? What clinical, operative, microbiological and functional metrics should be considered?

• Question 2: Is there a minimum number of periprosthetic joint infection (PJI) procedures that surgeons should perform annually that qualifies them as experts in the management of PJIs?

• Question 3: What tools (i.e. KLIC score) are available to help predict successful treatment with debridement, antibiotics, and implant retention (DAIR)? What are the accuracy of these tools?

• Question 4: What is the optimal follow-up plan (i.e. schedule, exam maneuvers, labs, imaging) for patients being treated for periprosthetic joint infections (PJIs)? b) How frequently should the inflammatory biomarkers be measured after the resection arthroplasty performed as part of two-stage exchange?

• Question 5: Is there a benefit for the engagement of a multidisciplinary team for the management of patients with periprosthetic joint infections (PJIs)?