title: Silver-Coated Hip Megaprosthesis in Oncological Limb Savage Surgery.
abstract: Silver coating has demonstrated good antimicrobial activity and low toxicity. Silver-coated megaprostheses have been introduced in oncological musculoskeletal surgery considering the high rate of infection. We conducted a retrospective analysis on 68 cases of primary or metastatic bone tumors, affecting the proximal femur, treated between 2005 and 2016 with wide margins resection and tumor implants reconstruction. All patients were treated by the same surgeon, with antibiotic prophylaxis according to a standard protocol. In 55.9% of patients silver-coated hip hemiarthroplasty was implanted; in the remaining 44.1% uncoated megaprostheses were implanted. Patients were reevaluated recording the complications and focusing the analysis on infective complications. The average follow-up was 46.5 months. No patient has shown any sign of local or general silver toxicity. A SEM analysis was conducted on the 3-silver-coated hip hemiarthroplasty explanted confirming a severe degradation with a small amount of residual silver on the coating surface. Silver-coated hip prostheses have a lower rate of early infection than traditional implants but showed a reduction of antimicrobial activity for silver coating wear. We recommend using silver-coated prosthesis as primary implants for limb salvage surgery, in primary or metastatic bone tumors affecting the proximal femur, considering the absence of signs of toxicity and the lower rate of early infection.
authors.affiliation: Division of Orthopedic and Traumatology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: F
authors.identifier: 0000-0003-1362-8502
authors.initials: F
authors.lastname: Donati
authors.affiliation: Division of Orthopedic and Traumatology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Di Giacomo
authors.affiliation: Division of Orthopedic and Traumatology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: S
authors.initials: S
authors.lastname: D'Adamio
authors.affiliation: Division of Orthopedic and Traumatology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: A
authors.identifier: 0000-0002-4656-7390
authors.initials: A
authors.lastname: Ziranu
authors.affiliation: Division of Orthopedic and Traumatology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: S
authors.initials: S
authors.lastname: Careri
authors.affiliation: Division of Orthopedic and Traumatology, Messina University, Messina, Italy.
authors.forename: Ma
authors.initials: M
authors.lastname: Rosa
authors.affiliation: Division of Orthopedic and Traumatology, Catholic University of the Sacred Heart, Rome, Italy.
authors.forename: G
authors.initials: G
authors.lastname: Maccauro
mesh_terms: D000328:Adult; D000368:Aged; D020099:Coated Materials, Biocompatible; D005260:Female; D005266:Femoral Neoplasms / Q000473:pathology / Q000556:secondary* / Q000601:surgery*; D005270:Femur Head / Q000473:pathology / Q000601:surgery*; D005272:Femur Neck / Q000473:pathology / Q000601:surgery*; D005500:Follow-Up Studies; D006622:Hip Prosthesis; D006801:Humans; D008297:Male; D008875:Middle Aged; D009362:Neoplasm Metastasis; D012189:Retrospective Studies; D012834:Silver
chemical_list: D020099:Coated Materials, Biocompatible; D012834:Silver