Silver-coated endoprosthetic replacement of the proximal humerus in case of tumour—is there an increased risk of periprosthetic infection by using a trevira tube?

Schmolders, Jan; Koob, Sebastian; Schepers, P.; Kehrer, Michael; Frey, Sönke P.; Wirtz, Dieter Christian; Pennekamp, P. H.; Strauß, Andreas C.

doi:10.1007/s00264-016-3329-6

Cited by 35 publications

(20 citation statements)

References 28 publications

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“…2 However, within each selected patient population and anatomical localization, silver-coated implants have consistently shown lower infection rates in comparison to other implants 18,[25][26] and our results corroborate these findings in the setting of an independent institution with longer follow-up from previous smaller patient series. 4,5,20,22,23 The overall 12 % infection rate of the presented study is almost identical to the previously published series of mixed primary resections with revision arthroplasty where Glehr et al 27 reported an infection rate of 12.5 % among 32 patients who had been treated with MUTARS® silver-coated endoprostheses and Wafa et al 18 reported an overall postoperative infection rate of 11.8 % in the silver-coated group of 85 Agluna-Stanmore Implants. Likewise, Schmolders et al 4 had to perform revision operations due to infection in 10 % of their implanted silver-coated MUTARS® endoprostheses after a median follow-up of 24 months for primary or metastatic oncological patients.…”

Section: Discussionsupporting

confidence: 87%

“…Furthermore, the results in revision arthroplasty patients are difficult to analyse within or between different centres due to different diagnostic methods of infection (e.g., sonication), perioperative antibiotic regiments, number of previous surgical procedures and pre-existing infections. All these limitations were also present in all other recent studies of this topic [1][2][3][4][5][6][19][20][21][22][23][24] where the infection-rate variability of silver-coated implants was larger between different patient populations (primary resection, metastases, revision, previous infection) and anatomical localizations than between different implant types (silver-coated vs. non-coated). 2 However, within each selected patient population and anatomical localization, silver-coated implants have consistently shown lower infection rates in comparison to other implants 18,[25][26] and our results corroborate these findings in the setting of an independent institution with longer follow-up from previous smaller patient series.…”

Section: Discussionmentioning

confidence: 96%

“…15,16 The antimicrobial efficacy of silver-coated endoprostheses has not yet been confirmed in randomized controlled studies, but several retrospective studies analysed different implants, 17,18 among them the widely used MUTARS® system (= Modular Universal Tumour And Revision System, Implantcast GmbH). [1][2][3][4]6,[19][20][21][22][23][24] These studies were either conducted by the main developmental hospital of this manufacturer (University Hospital Münster, Münster, Germany) 1,3,6,15,21,24 or in smaller centres with patient series of 25-40 patients and < 2 years follow-up. 4,5,20,22,23 So far no study has been published by an independent institution with the entire cohort of a hundred silver-coated MUTARS® implants and over 3 years of mean follow-up.…”

Section: Introductionmentioning

confidence: 99%

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Infection risk analysis of 101 silver-coated endoprostheses

Mavčič¹,

Martinčič²,

Špiler³

et al. 2019

Mater. Tehnol.

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Our aim was to analyse the implant survival and infection rates of 101 consecutive silver-coated MUTARS® (= Modular Universal Tumour And Revision System) endoprostheses implanted at an independent orthopaedic tertiary hospital between April 1, 2011 and December 31, 2018 and to compare them with previous outcomes of the MUTARS® developmental hospitals. In addition, we tested the hypothesis that the infection-free survival rates of silver-coated implants depend on the patient's age, gender, pre-operative diagnoses and anatomical localization of the reconstruction. The cohort included 47 sarcoma resections, 29 revision arthroplasties, 20 metastatic resections, 3 benign bone tumours and 2 primary arthroplasties. Endoprosthesis was located in the distal femur (38 patients), proximal femur (29 patients), proximal humerus (12 patients), proximal tibia (10 patients), pelvis (6 patients), total femur (5 patients) and distal humerus (1 patient). The mean age at implantation was 49 (range 11-86) years and the mean follow-up 3.2 (range 0.1-7.7) years. Twenty-four patients required at least one subsequent revision operation and 15 endoprostheses had to be partially/totally removed. Patients' age was an independent risk factor for postoperative infection regardless of other confounding factors (hazard ratio 1.05 for each year; p = 0.02). With the overall postoperative infection rate 12 % (4 % reinfection + 8 % newly acquired) and cumulative partial/total implant removal rate 25 % after 5 years, complications were comparable to the previous series of the MUTARS® developmental hospitals with high variability between preoperative diagnoses and anatomical localizations. Silver-coated implants show a consistent trend of preventing infections in high-risk body regions and enabling more successful treatment should infection occur, but 10-15 years of clinical follow-up is required for further assessment.

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Section: Discussionsupporting

confidence: 87%

Section: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Infection risk analysis of 101 silver-coated endoprostheses

Mavčič¹,

Martinčič²,

Špiler³

et al. 2019

Mater. Tehnol.

View full text Add to dashboard Cite

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“…Alternatively, when the rotator cuff needs to be resected, attachment tubes made from polyethylene terephthalate (PET) are available [35]. In 2016, Schmolders et al showed that a higher infection rate was not observed in their population of 30 patients with a proximal humerus replacement when treated with an attachment tube, even if the patients were receiving immunosuppression therapy [36]. In view of the high risk of infection with the use of megaprostheses, silver-coated versions are now available and should be used [37].…”

Section: Wide Resectionmentioning

confidence: 99%

Bone Metastases – Pathophysiology, Diagnostic Testing and Therapy (Part 2)

et al. 2019

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The second part of this review deals with the several options for the surgical therapy of bone metastases according to their anatomical site and the patientʼs individual prognosis. Although metastases to the bone – with few exceptions – are normally given palliative therapy, patients nowadays reach survival times of several months to years, depending on the underlying tumour entity. Scoring systems are suitable to estimate the patientʼs prognosis and fracture risk. The indication for operation has to be adapted to these parameters. In order to preserve a high quality of life, a limb saving procedure has to be aimed at. The options include the resection of the metastasis with stabilisation, the sole stabilisation of the affected bone, and wide resection with limb reconstruction using a modular tumor endoprosthesis. With todayʼs anaesthesiological peri- and intraoperative care, a vast number of surgical implants and bone augmentations are available. However, what is important is not the practicability of the procedure, but the oncological justification and patient-adapted selection of surgical therapy.

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“…1 AP radiograph of the pelvis and both hips with fracture-risk osteolytic lesion of the proximal femur. with proximal humeral replacement techniques the use of a silvercoated modular tumor endoprosthesis in combination with a trevira tube represents a safe and reliable treatment option which is not associated with a statistically increased risk or periprosthetic infection [28]. In patients with proximal bone defects of the shoulder region, alloarthroplastic joint replacement by means of a shoulder prosthesis is often the only treatment option remaining.…”

Section: Upper Extremitymentioning

confidence: 99%