Retrospective evaluation of the incidence of early periprosthetic infection with silver-treated endoprostheses in high-risk patients

Abstract

We conducted a case-control study to examine the merit of silver-coated tumour prostheses. We reviewed 85 patients with Agluna-treated (silver-coated) tumour implants treated between 2006 and 2011 and matched them with 85 control patients treated between 2001 and 2011 with identical, but uncoated, tumour prostheses. In all, 106 men and 64 women with a mean age of 42.2 years (18.4 to 90.4) were included in the study. There were 50 primary reconstructions (29.4%); 79 one-stage revisions (46.5%) and 41 two-stage revisions for infection (24.1%). The overall post-operative infection rate of the silver-coated group was 11.8% compared with 22.4% for the control group (p = 0.033, chi-square test). A total of seven of the ten infected prostheses in the silver-coated group were treated successfully with debridement, antibiotics, and implant retention compared with only six of the 19 patients (31.6%) in the control group (p = 0.048, chi-square test). Three patients in the silver-coated group (3.5%) and 13 controls (15.3%) had chronic periprosthetic infection (p = 0.009, chi-square test). The overall success rates in controlling infection by two-stage revision in the silver-coated group was 85% (17/20) compared with 57.1% (12/21) in the control group (p = 0.05, chi-square test). The Agluna-treated endoprostheses were associated with a lower rate of early periprosthetic infection. These silver-treated implants were particularly useful in two-stage revisions for infection and in those patients with incidental positive cultures at the time of implantation of the prosthesis. Debridement with antibiotic treatment and retention of the implant appeared to be more successful with silver-coated implants.

Length of Endoprosthetic Reconstruction in Revision Knee Arthroplasty Is Associated With Complications and Reoperations

“…Similar to their group, given the morbidity of infection in these implants, it is now our practice to place all patients with prostheses that extend into the diaphysis on empiric chronic antibiotic therapy postoperatively. Investigation of this prolonged antibiotic course as well as collaborative efforts with oncology colleagues on interventions like local antibiotic delivery or silver-coated prostheses warrants future attention [8,22].…”

Antimicrobial technology in orthopedic and spinal implants

“…Early clinical studies have shown promising results with regard to reducing periprosthetic infections. Wafa et al [49] retrospectively compared 85 patients with silvercoated tumor prostheses to 85 tumor patients with non-silver tumor prostheses. The authors found that the average infection rate among silver-coated implant patients was 10.6% lower than that of their uncoated counterparts.…”

Uso de recubrimientos protésicos de plata en cirugía tumoral: influencia en la tasa de infección

“…Aunque la plata posiblemente muestre menor actividad al ligarse a otras proteínas, mantiene la esterilidad de la superficie del implante ante la colonización bacteriana proveniente de las partes blandas (10) . Algunos autores han obtenido resultados que corroboran una menor tasa de infección con prótesis tumorales con recubrimiento de plata tras compararlas con otro grupo de pacientes en que se implantaron prótesis sin dicho recubrimiento, mostrando menores tasas de infección precoz y crónica (21) . Tras los resultados obtenidos en pacientes oncológicos, nuevas líneas de investigación se están abriendo, como el uso de recubrimientos de hidroxiapatita-plata para prótesis, que han demostrado la capacidad para inhibir el crecimiento bacteriano en estudios in vitro (22) .…”