Silver-coated megaprostheses in the proximal femur in patients with sarcoma

Streitbuerger, Arne; Henrichs, Marcel-Philipp; Hauschild, G; Nottrott, Markus; Guder, Wiebke; Hardes, Jendrik

doi:10.1007/s00590-018-2270-3

Cited by 36 publications

(42 citation statements)

References 28 publications

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“…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: Discussionmentioning

confidence: 96%

Section: Introductionmentioning

confidence: 99%

Infection risk analysis of 101 silver-coated endoprostheses

Mavčič¹,

Martinčič²,

Špiler³

et al. 2019

Mater. Tehnol.

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“…[ 13 , 14 ] In recent years, some researchers proposed a biodegradable antibiotic sustained release system [ 15 ] ; however, its application is still limited due to the deficiencies in material composites and drug- controlled release and other techniques. Arne et al developed silver-coated bone tumor prosthesis [ 8 ] ; however, it has not been widely used due to the complex preparation, high cost, unclear antibiotic mechanisms, and the risk of toxic and side-effects. Other researchers reported to construct an antibiotic controlled release microsphere system on surface of low-modulus of elasticity β titanium alloy implant, so as to develop new techniques for preparing antibiotic coating for metallic surface, [ 16 ] whereas it has not been applied in clinic.…”

Section: Discussionmentioning

confidence: 99%

“…Some researchers designed bone tumor prosthesis coated with silver to overcome high infection rate of giant bone tumor prosthesis. [ 8 ] However, preparation of this prosthesis is very complex and expensive, with unclear antibiotic mechanism, which confines its application. Referring to successful application of gentamicin bead chain and packing with antibiotic cement in revision hip arthroplasty, [ 3 , 4 ] we developed a custom-made bone tumor prosthesis coated with antibiotic cement for distal femoral tumors, and compared with traditional custom-made prosthesis to investigate its effect of infection control.…”

Section: Introductionmentioning

confidence: 99%

The anti-infective outcomes of the distal femoral replacement coated with antibiotic cement in limb salvage surgery

et al. 2022

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Background: The aim of this study was to observe the anti-infective effect of the distal femoral tumor prosthesis coated with antibiotic cement during limb salvage treatment, and evaluate its potential prospect in clinic. Methods: In this randomized controlled trial, the en bloc resection and reconstruction were performed in 36 patients with distal femoral primary bone tumor. Patients were divided into 2 groups randomly according to the application of antibiotic bone cement coating, which included antibiotic cement coating group (16 cases) and control group (18 cases). There were 10 men and 6 women in anti-infection group, aged from 18 to 54 years (23.47 ± 3.53), and there were 12 men and 6 women in control group, aged from 19 to 56 years (24.16 ± 4.32). The tumor type, age, sex, and Enneking stage were enrolled with well-matched of the 2 groups of patients. There was no difference between bundles and routine standard care for each group. The antibiotic cement was coated on the surface of polyethylene jacket with punched holes during operation. The peri-prosthetic infection, local recurrence and distant metastasis were followed up and limb functions were evaluated by Musculoskeletal Tumor Society 93 (MSTS93) scoring system. Results: Patients were followed up till 34.7 months (range 18∼62 months). There was no periprosthetic infection in anti-infection group. Four cases in control group showed deep infection. Infection rate had significant differences between the 2 groups ( P < .05). Infection-related prosthesis mortality was 0% (0/16) in anti-infection group and 16.67% (3/18) in control group. Local recurrence and distant metastasis occurred in 7 of 34 patients with primary malignant bone tumor, wherein 2 cases of local recurrence and 1 cases of distant metastasis occurred in anti-infective group; 2 cases of local recurrence and 2 cases of distant metastasis occurred in the control group. During a latest follow-up, MSTS93 function scoring revealed a mean of 25.6 ± 4.2 in anti-infection group and 18.5 ± 3.3 in control group. The survival rate of anti-infective group is 75%, and the survival rate of control group is 61.11%. Conclusion: The antibiotic cement-coated technique on the surface of the polyethylene jacket of custom-made distal femoral prosthesis is simple and effective in controlling the periprosthetic infection after tumor prosthesis reconstruction.

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“…Silver ion (Ag + ) has reached wide utilization area from jewelry designing [14] to photography [15] and electronic industry [16] over the years due to its prominent characteristics such as high thermal [17] and electrical conductivity [18], contact resistance [19] etc. Furthermore, due to its high antibacterial [20] and antifungal characteristics [20,21], silver ion is frequently used in medical applications as well, such as production of bone prostheses [22], dental amalgams [23], and catheters [24]. Besides, silver ion could be used as a therapeutic agent in the treatment of many other disorders, for instance mental illness, epilepsy , infectious diseases, nicotine addiction etc [25].…”

Section: Circular Dichroism (Cd) Spectrophotometry Analysismentioning

confidence: 99%

Triplex-forming DNA Probe Approach for Silver Detection and the Effect of C-G·C Triplet Distribution on Triplex Stability

Doluca

2019

Hittite J. Sci. Eng.

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B esides the knowledge that DNA is the primary hereditary molecule with possessing genetic code hidden in its double stranded helix form (B-form), an increasing number of evidence demonstrate that DNA, due to its non-canonical (non-B-form) structures, have regulatory functions on various cellular processes as well [1]. While duplex form of DNA is built up via Watson-Crick base pairing edges of nucleotide residues, some forms of the DNA are created by binding of auxiliary strands to a duplex DNA via Hoogsten base pairing edges of nucleotides [2,3]. In particular, triplex DNA forms have become one of the primary research areas due to the possibility of targeting regulatory regions of several oncogenes [2][3][4] and that their providing ease to manipulation due to exhibiting high stability in comparison to duplex forms [5].These triplex DNA forms could be created via binding of an auxiliary strand which is either rich in purine or pyrimidine, purine rich strand of the duplex DNA [6].

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Silver-coated megaprostheses in the proximal femur in patients with sarcoma

Abstract: Using a silver-coated proximal femoral replacement nearly halved the overall infection rate. When infections occurred, it was usually possible to avoid two-stage prosthesis exchanges in the silver group.

Cited by 36 publications

References 28 publications

Infection risk analysis of 101 silver-coated endoprostheses

Infection risk analysis of 101 silver-coated endoprostheses

The anti-infective outcomes of the distal femoral replacement coated with antibiotic cement in limb salvage surgery

Triplex-forming DNA Probe Approach for Silver Detection and the Effect of C-G·C Triplet Distribution on Triplex Stability

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