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Journal of Orthopaedic Research Volume 32, Issue S1 p. S172-S172

Future Research

The workgroup has identified the following as potential topics in need of further research.

  • Influence of immunosuppression/immunosuppressive state on the incidence of PJI/SSI
  • Influence of HIV and/or IV drug abuse on the incidence of SSI/PJI?
  • Role of routine urinary tract screening in patients undergoing elective arthroplasty
  • Optimal timing for elective arthroplasty for patients with prior septic arthritis
  • The threshold for synovial cell count and neutrophil differential indicative of no active infection in patients with prior septic arthritis
  • The threshold for synovial cell count and neutrophil differential indicative of active infection in patients with suspected PJI
  • The role of preoperative showering or skin wipes for lowering SSI/PJI
  • The role of terminal cleansing of hand with alcohol prior to surgery
  • Duration of hand wash prior to surgery
  • Cross reactivity of cephalosporins in patients with penicillin allergy
  • Use of dual antibiotics for prevention of PJI
  • The indications for administration of vancomycin for patients undergoing elective joint arthroplasty
  • Studies to explore association between patients with preoperative abnormal urine tests and subsequent SSI/PJI
  • MRSA screening and decolonization: efficacy of decolonization, incidence of recolonization/persistence of colonization, what element of decolonization (nasal decontamination, skin decontamination or prophylactic antibiotic) are the most effective strategy for prevention of PJI?
  • The role of newly introduced agents (such as betadine based products) for decolonization of patients with MRSA prior to elective arthroplasty
  • Investigation of newer methods (other than conventional) culture for identification of MRSA colonized patients
  • The appropriate prophylactic antibiotic for patients undergoing megaprosthesis/tumor surgery
  • Does the use of laminar flow room reduce the incidence of subsequent SSI/PJI following total joint arthroplasty?
  • Does the use of body exhaust system reduce the incidence of subsequent SSI/PJI following total joint arthroplasty?
  • Should patients wear a face mask during TJA?
  • Can an uninfected elective arthroplasty be done after a prior infected case in the operating room?
  • The best method of operating room decontamination
  • How often should gloves be changed during joint arthroplasty?
  • Should incise draping be used during TJA?
  • Type/volume/timing of irrigation solution
  • Use of dilute betadine during TJA for prevention of SSI. Determine optimal dose and duration of irrigation
  • Does type of draping (disposable vs. non‐disposable) affect the incidence of SSI/PJI?
  • Use of autologous blood derived products for reduction of blood loss and subsequent SSI/PJI
  • Best method of skin closure in patients undergoing elective total joint arthroplasty
  • Best method of skin closure in patients undergoing surgical treatment for PJI
  • Does the use of silver impregnated dressing reduce the incidence of SSI/PJI?
  • The best method of hand cleansing prior to surgery
  • Use of vancomycin powder in the wound for prevention of PJI in patients undergoing TJA
  • Sonication of prosthesis for diagnosis of PJI (reproducing results)
  • Study to determine the indications for aspiration of joints prior to revision for assumed aseptic failures
  • Risk factors for failure of irrigation and debridement
  • Use of resorbable material for delivery of antibiotics for prevention/treatment of PJI
  • Randomized study to determine the success of one stage versus two stage
  • Study to determine the optimal timing of reimplantation
  • Study to identify proper serum or synovial tests to determine timing of reimplantation
  • Study to determine the optimal length of antibiotic treatment between two stages
  • Indications and length of treatment for suppressive ABx therapy following surgical managements of PJI
  • Dental prophylaxis for those with TJA
  • The role of maintaining normothermia during orthopaedic procedures
  • Study to determine if prophylactic antibiotics are needed for patients undergoing colonoscopy or other minor procedures.

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