Can a Silver-Coated Arthrodesis Implant Provide a Viable Alternative to Above Knee Amputation in the Unsalvageable, Infected Total Knee Arthroplasty?

Wilding, Christopher P; Cooper, G. M.; Freeman, Alexandra K.; Parry, Michael; Jeys, Lee

doi:10.1016/j.arth.2016.04.009

Cited by 41 publications

(31 citation statements)

References 43 publications

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“…34 Interestingly, in our series, the mean functional scores in the KA group were comparable to those of the EPR group, though with a greater deviation from the mean. In addition, OKS values in group A were similar to those of a previous small series by Wilding et al, 16 who reported the use of silver-coated KA implants for failed infected revision TKR. We reported a mean MSTS of 20 in the EPR group which is lower than that reported for primary PT EPR but higher than previous data reporting on PT EPR revised for infection.…”

Section: Discussionsupporting

confidence: 87%

“…11 When compared with amputation, KA has consistently been shown to confer better functional outcomes, with ambulation reported in 84 to 100% of patients. 15,16 When compared with repeated revision with mobile EPR, KA has been shown to reduce rates of reinfection, although studies are small and often include heterogeneous populations. 16,17 The aim of this multicentric retrospective study was to assess whether KA is more effective than EPR for infection control following two-stage revision for infection of PT EPR.…”

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confidence: 99%

“…15,16 When compared with repeated revision with mobile EPR, KA has been shown to reduce rates of reinfection, although studies are small and often include heterogeneous populations. 16,17 The aim of this multicentric retrospective study was to assess whether KA is more effective than EPR for infection control following two-stage revision for infection of PT EPR. Second, we questioned if KA has a higher rate of limb salvage in case of reinfection and what is the function of KA compared with EPR after multiple revisions.…”

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confidence: 99%

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Is Arthrodesis a Reliable Salvage Option following Two-Stage Revision for Suspected Infection in Proximal Tibial Replacements? A Multi-Institutional Study

et al. 2018

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The aim of this multicentric retrospective study was to verify whether knee arthrodesis (KA) is a viable reconstructive option after two-stage revision for infection of proximal tibia (PT) endoprosthetic reconstruction (EPR). Sixty patients who underwent a two-stage revision were included. Definitive EPR or a KA with a modular system was performed following consideration of soft tissue and extensor mechanism conditions. Patients were evaluated with Musculoskeletal Tumor Society Score and Oxford Knee Score. Implant survival was assessed on the basis of recurrence of infection. Five patients did not receive any reconstruction after the first stage. In 14 cases, a KA was performed, and in 41, an EPR was implanted. At 5 years follow-up, reinfection rate in the KA group was lower (10 vs. 17.5% in KA and EPR groups, respectively). In reinfected patients, the KA group had a reduced rate of amputation when compared with those with EPR (50 vs. 88%). Functional evaluation did not show any significant differences between the two groups. A successful KA using a modular implant can eradicate infection and allow preservation of the limb with good function and good pain relief in after two-stage revision for an infected PT EPR.

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Section: Discussionsupporting

confidence: 87%

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confidence: 99%

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confidence: 99%

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Is Arthrodesis a Reliable Salvage Option following Two-Stage Revision for Suspected Infection in Proximal Tibial Replacements? A Multi-Institutional Study

et al. 2018

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“…Recently, silver coating of medical devices, such as external fixation pins, heart valves, endotracheal tubes, and cardiac and urinary catheters, has been shown to reduce infection rates [ 18 – 20 ]. Furthermore, several clinical studies have confirmed the positive effects of silver coatings in preventing infections in endoprostheses [ 21 – 23 ]. This seems to be a probable method of preventing infection in particularly complex defect cases, where cured bone infections of the lower extremity are supplied with a modular mega-endoprosthesis.…”

Section: Introductionmentioning

confidence: 99%

Silver-coated modular Megaendoprostheses in salvage revision arthroplasty after periimplant infection with extensive bone loss – a pilot study of 34 patients

Zajonz

Birke

Ghanem

et al. 2017

BMC Musculoskelet Disord

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BackgroundHip and knee replacements in patients with bone defects after infection correlates with high rates of reinfection. In this vulnerable patient population, the prevention of reinfection is to be considered superordinate to the functionality and defect bridging. The use of silver coating of aseptic implants as an infection prophylaxis is already proven; however, the significance of these coatings in septic reimplantation of large implants is still not sufficiently investigated.MethodsIn a retrospective analysis, 34 patients who have been treated with a modular mega-endoprosthesis after a cured bone infection of the lower limb (femur or tibia) have been evaluated. One group with 14 patients (NSCG: non silver- coated group) was supplied with the non silver- coated implants: MML München- Lübeck™ modular endoprosthesis system (AQ Implants, Ahrensburg, Germany) or MUTARS® Modular Universal Tumor And Revision System (Implantcast GmbH, Buxtehude, Germany). The other group with 20 patients (SCG: silver- coated group) was supplied with the silver- coated system of MUTARS®. In addition to the clinical findings and the patients’ histories, specifically the reinfection rates, the patients’ mobility was assessed using the New Mobility Score (NMS, by Parker and Palmer).ResultsThe median follow-up period was 72 months, ranging from 6 to 267 months. The dropout rate was 5.8%. The reinfection rate after healed reinfection in SCG was 40% (8/20), in NSCG 57% (8/14), p = 0.34; α =0.05. The time for reinfection was, on average, 14 months (1–72 months) in SCG and 8 months (1–48 months) in the NSCG (p = 0.61; α =0.05). The two groups showed no differences in the NMS.ConclusionWith this retrospective analysis, it can be determined that the rate of reinfection of modular mega-endoprostheses on the hip and knee joint after healed periprosthetic joint infection (PJI) can be reduced by the use of silver coated implants. The time until reinfection can also be delayed by utilizing silver coated implants. Due to the low number of cases of this highly specific patient population, no statistical significance could be determined. A positive effect, however, can be assumed through the use of silver coatings in mega-endoprostheses after an infectious situation.

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“…Studies on other coatings and their properties, such as silver coatings are also underway. (Wilding et al, 2016;Eto et al, 2016;Taga et al, 2018). Our research showed that biomaterials containing silver have antibacterial properties both against Gr+ and Gr-bacteria when compared to biomaterials without silver particles.…”

Section: Discussionmentioning

confidence: 64%

Adhesion and Colonisation of Microorganisms on Porous TiO₂ and TiO₂-Silver Biomaterials

Skadiņš

Micko

Zvaigzne

et al. 2019

Proceedings of the Latvian Academy of Sciences. Section B. Natural, Exact, and Applied Sciences.

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Bone graft transplantation is one of the most common transplants in the world and there has been a significant increase in the use of biomaterials in this sector. Bone substitutes are widely used in traumatology, orthopaedics, maxillofacial surgery and dentistry. The culturing method was used to determine microorganism ability to attach and form biofilms on originally synthesised porous TiO2 and TiO2Ag ceramics. The aim of this study was to determine and compare the intensity of adhesion and colonisation of Staphylococcus epidermidis, Pseudomonas aeruginosa and Candida albicans on TiO2 and TiO2Ag ceramics. The lowest adhesion and colonisation were on TiO2Ag samples for S. epidermidis and P. aeruginosa.No C. albicans adhesion and colonisation differences were found on TiO2 and TiO2Ag ceramic samples.

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Can a Silver-Coated Arthrodesis Implant Provide a Viable Alternative to Above Knee Amputation in the Unsalvageable, Infected Total Knee Arthroplasty?

Cited by 41 publications

References 43 publications

Is Arthrodesis a Reliable Salvage Option following Two-Stage Revision for Suspected Infection in Proximal Tibial Replacements? A Multi-Institutional Study

Is Arthrodesis a Reliable Salvage Option following Two-Stage Revision for Suspected Infection in Proximal Tibial Replacements? A Multi-Institutional Study

Silver-coated modular Megaendoprostheses in salvage revision arthroplasty after periimplant infection with extensive bone loss – a pilot study of 34 patients

Adhesion and Colonisation of Microorganisms on Porous TiO₂ and TiO₂-Silver Biomaterials

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Can a Silver-Coated Arthrodesis Implant Provide a Viable Alternative to Above Knee Amputation in the Unsalvageable, Infected Total Knee Arthroplasty?

Cited by 41 publications

References 43 publications

Is Arthrodesis a Reliable Salvage Option following Two-Stage Revision for Suspected Infection in Proximal Tibial Replacements? A Multi-Institutional Study

Is Arthrodesis a Reliable Salvage Option following Two-Stage Revision for Suspected Infection in Proximal Tibial Replacements? A Multi-Institutional Study

Silver-coated modular Megaendoprostheses in salvage revision arthroplasty after periimplant infection with extensive bone loss – a pilot study of 34 patients

Adhesion and Colonisation of Microorganisms on Porous TiO2 and TiO2-Silver Biomaterials

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Adhesion and Colonisation of Microorganisms on Porous TiO₂ and TiO₂-Silver Biomaterials