Michael C Parry1, Minna K Laitinen2, Jose I Albergo3, Czar L Gaston4, Jonathan D Stevenson5, Robert J Grimer5, Lee M Jeys5. 1. Royal Orthopaedic Hospital Oncology Service, Royal Orthopaedic Hospital NHS Foundation Trust, B31 2lA, UKP, Birmingham, UK. Electronic address: michael.parry3@nhs.net. 2. Department of Orthopaedics and Traumatology, Helsinki University General Hospital, Topeliuksenkatu 5, 00260, Helsinki, Finland. 3. Hospital Italiano Buenos Aires, 4190, Buenos Aires, Argentina. 4. Department of Orthopaedics, Musculoskeletal Tumor Unit, Philippine General Hospital, Manila, 1000, Philippines. 5. Royal Orthopaedic Hospital Oncology Service, Royal Orthopaedic Hospital NHS Foundation Trust, B31 2lA, UKP, Birmingham, UK.
Abstract
INTRODUCTION: Endoprostheses in the treatment of extremity sarcomas are associated with late complications including periprosthetic infection. This study analysed the incidence of infection in patients undergoing endoprosthetic replacement (EPR) with a silver-coated prosthesis. MATERIALS AND METHODS: The study comprised a retrospective single centre study of 394 consecutive patients treated with resection and EPR for primary extremity bone tumours. RESULTS: 89 patients at risk for infection were treated with a silver-coated (Agluna®) EPR (22.6%), compared to 305 patients treated with a non-silver EPR (77.4%). The incidence of periprosthetic infection, requiring revision as the primary endpoint was 34/394 (8.6%); 11 patients (12.4%) in the silver group and 23 patients (7.5%) in the non-silver group (p = 0.154). Overall implant survival was 90.9% and 95.3% at 1-year and 86.8% and 91.8% at 5-years in the silver-coated and non-silver coated group, respectively (p = 0.193). Infection was treated in the silver group by washout of the prosthesis in 2/11, debridement and implant retention (DAIR) in 1/11 and single-stage revision in 1/11, and in the non-silver group by washout in 1/23 or DAIR in 2/23. Two-stage revision was successful in 2/11in the silver group, and in 11/23 in the non-silver group. Amputation was required in 4/11 in the silver group and 9/23 in the non-silver group. One patient in the silver group died due to disease with an infected EPR. CONCLUSIONS: Silver-coated prostheses in high risk patients show similar infection free survival as non-silver coated prosthesis in standard sites in primary bone tumours of the extremities.
INTRODUCTION: Endoprostheses in the treatment of extremity sarcomas are associated with late complications including periprosthetic infection. This study analysed the incidence of infection in patients undergoing endoprosthetic replacement (EPR) with a silver-coated prosthesis. MATERIALS AND METHODS: The study comprised a retrospective single centre study of 394 consecutive patients treated with resection and EPR for primary extremity bone tumours. RESULTS: 89 patients at risk for infection were treated with a silver-coated (Agluna®) EPR (22.6%), compared to 305 patients treated with a non-silver EPR (77.4%). The incidence of periprosthetic infection, requiring revision as the primary endpoint was 34/394 (8.6%); 11 patients (12.4%) in the silver group and 23 patients (7.5%) in the non-silver group (p = 0.154). Overall implant survival was 90.9% and 95.3% at 1-year and 86.8% and 91.8% at 5-years in the silver-coated and non-silver coated group, respectively (p = 0.193). Infection was treated in the silver group by washout of the prosthesis in 2/11, debridement and implant retention (DAIR) in 1/11 and single-stage revision in 1/11, and in the non-silver group by washout in 1/23 or DAIR in 2/23. Two-stage revision was successful in 2/11in the silver group, and in 11/23 in the non-silver group. Amputation was required in 4/11 in the silver group and 9/23 in the non-silver group. One patient in the silver group died due to disease with an infected EPR. CONCLUSIONS:Silver-coated prostheses in high risk patients show similar infection free survival as non-silver coated prosthesis in standard sites in primary bone tumours of the extremities.
Authors: Federico Sacchetti; Raphael Kilian; Francesco Muratori; Stephane Cherix; Lorenzo Foschi; Riccardo Morganti; Domenico Andrea Campanacci; Rodolfo Capanna Journal: Arch Bone Jt Surg Date: 2022-05
Authors: Vahid Zarghami; Mohammad Ghorbani; Kamran Pooshang Bagheri; Mohammad Ali Shokrgozar Journal: J Mater Sci Mater Med Date: 2022-05-21 Impact factor: 4.727