title: Retrospective evaluation of the incidence of early periprosthetic infection with silver-treated endoprostheses in high-risk patients: case-control study.
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.
authors: Glasgow Royal Infirmary, 84, Castle Street, Glasgow, G4 0SF, UK.
authors: H
authors: H
authors: Wafa
authors: Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
authors: R J
authors: RJ
authors: Grimer
authors: Vanderbilt Orthopaedic Institute, 1215 21st Avenue South, Medical Center East, S Tower, Suite 4200, Nashville, Tennessee, 37232-8774, USA.
authors: K
authors: K
authors: Reddy
authors: Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
authors: L
authors: L
authors: Jeys
authors: Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
authors: A
authors: A
authors: Abudu
authors: Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
authors: S R
authors: SR
authors: Carter
authors: Royal Orthopaedic Hospital, Bristol Road South, Northfield, Birmingham, B31 2AP, UK.
authors: R M
authors: RM
authors: Tillman
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001859:Bone Neoplasms / Q000601:surgery*; D016022:Case-Control Studies; D020099:Coated Materials, Biocompatible; D003646:Debridement; D005260:Female; D005266:Femoral Neoplasms / Q000601:surgery; D006801:Humans; D015994:Incidence; D008297:Male; D016555:Matched-Pair Analysis; D008875:Middle Aged; D019736:Prostheses and Implants / Q000009:adverse effects*; D016459:Prosthesis-Related Infections / Q000453:epidemiology* / Q000517:prevention & control*; D012086:Reoperation; D012834:Silver / Q000008:administration & dosage*; D013977:Tibia; D055815:Young Adult
chemical_list: D020099:Coated Materials, Biocompatible; D012834:Silver
keywords: endoprosthetic replacement; periprosthetic infection; silver endoprostheses; two-stage revision surgery