title: Silver-coated megaendoprostheses in a rabbit model--an analysis of the infection rate and toxicological side effects.
abstract: Deep infection of megaprostheses remains a serious complication in orthopedic tumor surgery. Despite the use of systemic and local antibiotic prophylaxis the reported infection rate is between 5% and 35%. Silver-coated medical devices proved their effectiveness in reducing infections. The objective of this study was to examine in vivo the antimicrobial efficacy and possible side-effects of a silver-coated megaprosthesis. In a first study, 30 rabbits (15 titanium versus 15 silver-coated Mutars-endoprostheses) were infected with Staphylococcus aureus. In a second study, toxicological side effects were analyzed in 10 rabbits with a silver-coated megaprosthesis. The silver group showed significantly (p<0.05) lower infection rates (7% versus 47%) in comparison with the titanium group. Measurements of the C-reactive-protein, neutrophilic leukocytes, rectal temperature and body weight showed significant (p<0.05) lower signs of inflammation in the silver group. The analysis of the silver concentration in blood (median 1.883ppb) and in organs (0.798-86.002ppb) showed elevated silver concentrations without pathologic changes in laboratory parameters and without histological changes of organs. In conclusion, the new silver-coated Mutars-megaprosthesis resulted in reduced infection rates without toxicological side effects, suggesting that this prosthesis might be a promising device in tumor surgery exhibiting antimicrobial activity.
authors.affiliation: Department of Orthopedics, University of Muenster, Albert-Schweitzer-Str. 33, 48149 Muenster, Germany. goshegg@uni-muenster.de
authors.forename: Georg
authors.initials: G
authors.lastname: Gosheger
authors.forename: Jendrik
authors.initials: J
authors.lastname: Hardes
authors.forename: Helmut
authors.initials: H
authors.lastname: Ahrens
authors.forename: Arne
authors.initials: A
authors.lastname: Streitburger
authors.forename: Horst
authors.initials: H
authors.lastname: Buerger
authors.forename: Michael
authors.initials: M
authors.lastname: Erren
authors.forename: Andreas
authors.initials: A
authors.lastname: Gunsel
authors.forename: Fritz H
authors.initials: FH
authors.lastname: Kemper
authors.forename: Winfried
authors.initials: W
authors.lastname: Winkelmann
authors.forename: Christof
authors.initials: C
authors.lastname: Von Eiff
mesh_terms: D000818:Animals; D005260:Female; D017053:Infection Control / Q000379:methods*; D023421:Models, Animal; D019736:Prostheses and Implants; D011817:Rabbits; D012834:Silver / Q000633:toxicity
chemical_list: D012834:Silver