Reduction of periprosthetic infection with silver‐coated megaprostheses in patients with bone sarcoma

Abstract

Background and Objectives: The placement of megaprostheses in patients with bone sarcoma is associated with high rates of infection, despite prophylactic antibiotic administration. In individual cases, secondary amputation is unavoidable in the effort to cure infection. Methods: The infection rate in 51 patients with sarcoma (proximal femur, n ¼ 22; proximal tibia, n ¼ 29) who underwent placement of a silver-coated megaprosthesis was assessed prospectively over a 5-year period, along with the treatment administered for infection. The infection rate was compared with the data for 74 patients in whom an uncoated titanium megaprosthesis (proximal femur, n ¼ 33; proximal tibia, n ¼ 41) was implanted. Results: The infection rate was substantially reduced from 17.6% in the titanium to 5.9% in the silver group. Whereas 38.5% of patients in the titanium group ultimately had to undergo amputation when periprosthetic infection developed, these mutilating surgical procedures were not necessary in the study group. Conclusions: The use of silver-coated prostheses reduced the infection rate in the medium term. In addition, less aggressive treatment of infection was possible in the group with silver-coated prostheses. Further studies with longer term follow-up periods and larger numbers of patients are warranted in order to confirm these encouraging results.

Medical Comorbidities Are Independent Preoperative Risk Factors for Surgical Infection After Total Joint Arthroplasty

“…Although categorical definitions are convenient, it may be prudent to move toward describing obesity with a specific BMI in patients with extreme body weight. The high OR reported for current or prior bone malignancy such as sarcoma or metastatic cancer was expected, because the use of megaprosthetics in orthopaedic oncology has been reported to have infection rates of approximately 18% [10]. However, the association between a history of staphylococcus infection or colonization and future infection rates was surprising, because the infection or colonization in many cases was documented as much as 10 years before surgery.…”

Management of infection following reconstruction in bone tumors

“…Periprosthetic infections are prevalent despite the use of systemic antibiotic treatment, operating rooms with laminar airflow, and routine screening for methicillin-resistant Staphylococcus aureus (MRSA). 39 In the literature, infection rates of 3-31% have been reported (average approx. 15%), often in conjunction with risk factors, e.g.…”

“…37 The rate of infections varies according to the site of replacement with lower rates in upper extremities and higher rates in lower extremities. [39][40][41][42][43][44] However postsurgical infection is more common in pelvic tumor surgeries. Several authors have reported infection rates ranging from 12% to 47%.…”

“…Other factors include prolonged operating time, wide surgical exposure, use of chemotherapy/radiotherapy, proximity of the rectum and genitourinary tract, size of the implant, and blood supply to the skin flap. 37,6,39,[45][46][47][48] Regarding infection rates with regard to specific diagnosis, sarcomas demonstrated the highest infection rate of 21.7% when compared to metastatic or non-metastatic disease (Table 2). 36 Usually high infection rates are seen after …”

Antibacterial and Biocompatible Titanium-Copper Oxide Coating May Be a Potential Strategy to Reduce Periprosthetic Infection: An In Vitro Study

“…Silvercoated megaprostheses are currently available in Europe for clinical use in tumor surgery. Infection reduction has been modest with this approach and argyria, a bluish skin decoloration caused by abnormal silver compound deposits, has been reported in up to 20% of patients [9,15,23,45].…”