The Performances of Conventional Titanium and Silver-Coated Megaprostheses in Non-oncological and Post-oncological Patients: An Analysis of Infection Failures in 142 Patients

Document Type : RESEARCH PAPER

Authors

1 Department of Orthopaedic and Trauma Surgery, University of Pisa, Italy

2 Department of Ophtalmology, Azienda Ospedaliera Universitaria Integrata, Verona, Italy

3 Department of Oncology and Surgery at Robotic Address of the Hospital Careggi University of Florence, Firenze FI, Italy

4 Department of Orthopaedic and Trauma Surgery, Centre Hospitalier Universitaire Vaudois, Lausanne, Switzerland

Abstract

Background: Megaprostheses are one of the preferred choices of reconstruction after tumor resection. Periprosthetic 
joint infections are one of the most serious complications of joint prostheses surgeries. In this study, our aim was to 
analyze the efficacy of silver-coated megaprostheses in reducing the risk of prosthesis-related infection.
Methods: One hundred forty-two patients who had undergone implantation of a mega-endoprosthesis for nonneoplastic or post-neoplastic conditions were included in this retrospective study. The end-point of the survival analysis 
was the prosthesis failure due to infection. 
Results: Thirty-eight patients had undergone implantation of a silver-coated megaprosthesis and 104 patients a 
megaprosthesis without silver coating. The survival analysis showed an overall infection-free survival rate of 82.3% at 
five years and 61.9% at 10 years. Silver-coated prostheses had an HR of 0.72 (95% CI: 0.26-2.05; P=0.54).
Conclusion: Implantation of a silver-coated mega-prosthesis in non-oncological patients did not significantly reduce 
the risk of prosthesis-related infection.
Level of evidence: III

Keywords


  1. Malawer MM, Henshaw RM, Kellar-Graney K. Overview of Endoprosthetic Reconstruction. Operative Techniques in Orthopaedic Surgical Oncology. 2012:34-45.
  2. Gkavardina A, Tsagozis P. The use of megaprostheses for reconstruction of large skeletal defects in the extremities: a critical review. Open Orthop J. 2014;8:384-9.
  3. Al-Taki MM, Masri BA, Duncan CP, Garbuz DS. Quality of life following proximal femoral replacement using a modular system in revision THA. Clin Orthop Relat Res. 2011; 469(2):470-5.
  4. Alvand A, Grammatopoulos G, de Vos F, Scarborough M, Kendrick B, Price A, et al. Clinical Outcome of Massive Endoprostheses Used for Managing Periprosthetic Joint Infections of the Hip and Knee. J Arthroplasty. 2018;33(3):829-834.
  5. Artiaco S, Boggio F, Colzani G, Titolo P, Zoccola K, Bianchi P, et al. Megaprostheses in the Revision of Infected Total Hip Arthroplasty. Clinical Series and Literature Review. Bull Hosp Jt Dis (2013). 2015;73(4):229-32.
  6. De Gori M, Scoccianti G, Frenos F, Bettini L, Familiari F, Gasparini G, et al. Modular Endoprostheses for Nonneoplastic Conditions: Midterm Complications and Survival. Biomed Res Int. 2016;2016:2606521.
  7. Bettin CC, Weinlein JC, Toy PC, Heck RK. Distal Femoral Replacement for Acute Distal Femoral Fractures in Elderly Patients. J Orthop Trauma. 2016;30(9):503-9.
  8. Calori GM, Colombo M, Malagoli E, Mazzola S, Bucci M, Mazza E. Megaprosthesis in post-traumatic and periprosthetic large bone defects: Issues to consider. Injury. 2014;45 Suppl 6:S105-10.
  9. Evans S, Laugharne E, Kotecha A, Hadley L, Ramasamy A, Jeys L. Megaprostheses in the management of trauma of the knee. J Orthop. 2015;13(4):467-471.
  10. Korim MT, Esler CN, Reddy VR, Ashford RU. A systematic review of endoprosthetic replacement for non-tumour indications around the knee joint. Knee. 2013;20(6):367-75.
  11. Korim MT, Esler CN, Ashford RU. Systematic review of proximal femoral arthroplasty for non-neoplastic conditions. J Arthroplasty. 2014;29(11):2117-21.
  12. Schoenfeld AJ, Leeson MC, Vrabec GA, Scaglione J, Stonestreet MJ. Outcomes of modular proximal femoral replacement in the treatment of complex proximal femoral fractures: a case series. Int J Surg. 2008;6(2):140-6.
  13. Toepfer A, Harrasser N, Petzschner I, Pohlig F, Lenze U, Gerdesmeyer L, et al. Short- to long-term follow-up of total femoral replacement in non-oncologic patients. BMC Musculoskelet Disord. 2016;17(1):498.
  14. Vasso M, Beaufils P, Cerciello S, Schiavone Panni A. Bone loss following knee arthroplasty: potential treatment options. Arch Orthop Trauma Surg. 2014;134(4):543-53.
  15. Windhager R, Schreiner M, Staats K, Apprich S. Megaprostheses in the treatment of periprosthetic fractures of the knee joint: indication, technique, results and review of literature. Int Orthop. 2016;40(5):935-43.
  16. De Gori M, Gasparini G, Capanna R. Risk Factors for Perimegaprosthetic Infections After Tumor Resection. Orthopedics. 2017;40(1):e11-e16.
  17. George DA, Gant V, Haddad FS. The management of periprosthetic infections in the future: a review of new forms of treatment. Bone Joint J. 2015;97-B(9):1162-9.
  18. Osmon DR. Microbiology and Antimicrobial Challenges of Prosthetic Joint Infection. J Am Acad Orthop Surg. 2017; 25 Suppl 1:S17-S19.
  19. Tande AJ, Patel R. Prosthetic joint infection. Clin Microbiol Rev. 2014;27(2):302-45.
  20. Tande AJ, Gomez-Urena EO, Berbari EF, Osmon DR. Management of Prosthetic Joint Infection. Infect Dis Clin North Am. 2017;31(2):237-252.
  21. Haijie L, Dasen L, Tao J, Yi Y, Xiaodong T, Wei G. Implant Survival and Complication Profiles of Endoprostheses for Treating Tumor Around the Knee in Adults: A Systematic Review of the Literature Over the Past 30 Years. J Arthroplasty. 2018;33(4):1275-1287.e3.
  22. Henderson ER, Groundland JS, Pala E, Dennis JA, Wooten R, Cheong D, et al. Failure mode classification for tumor endoprostheses: retrospective review of five institutions and a literature review. J Bone Joint Surg Am. 2011;93(5):418-29.
  23. Alt V. Antimicrobial coated implants in trauma and orthopaedics-A clinical review and risk-benefit analysis. Injury. 2017;48(3):599-607.
  24. Gallo J, Holinka M, Moucha CS. Antibacterial surface treatment for orthopaedic implants. Int J Mol Sci. 2014;15(8):13849-80.
  25. Ezquerra AA, Bona AP. Uso de recubrimientos protésicos de plata en cirugía tumoral: influencia en la tasa de infección. Revista de la Facultad de Ciencias Médicas de Córdoba. 2017;74(3):239-242.
  26. Cheng H, Li Y, Huo K, Gao B, Xiong W. Long-lasting in vivo and in vitro antibacterial ability of nanostructured titania coating incorporated with silver nanoparticles. J Biomed Mater Res A. 2014;102(10):3488-99.
  27. Donati F, Di Giacomo G, D’Adamio S, Ziranu A, Careri S, Rosa M, et al. Silver-Coated Hip Megaprosthesis in Oncological Limb Savage Surgery. Biomed Res Int. 2016;2016:9079041.
  28. Hardes J, Henrichs MP, Hauschild G, Nottrott M, Guder W, Streitbuerger A. Silver-Coated Megaprosthesis of the Proximal Tibia in Patients With Sarcoma. J Arthroplasty. 2017;32(7):2208-2213.
  29. Schmidt-Braekling T, Streitbuerger A, Gosheger G, Boettner F, Nottrott M, Ahrens H, et al. Silver-coated megaprostheses: review of the literature. Eur J Orthop Surg Traumatol. 2017;27(4):483-489.
  30. Schmolders J, Koob S, Schepers P, Pennekamp PH, Gravius S, Wirtz DC, et al. Lower limb reconstruction in tumor patients using modular silver-coated megaprostheses with regard to perimegaprosthetic joint infection: a case series, including 100 patients and review of the literature. Arch Orthop Trauma Surg. 2017;137(2):149-153.
  31. Streitbuerger A, Henrichs MP, Hauschild G, Nottrott M, Guder W, Hardes J. Silver-coated megaprostheses in the proximal femur in patients with sarcoma. Eur J Orthop Surg Traumatol. 2019;29(1):79-85.
  32. Sambri A, Zucchini R, Giannini C, Zamparini E, Viale P, Donati DM, et al. Silver-coated (PorAg®) endoprosthesis can be protective against reinfection in the treatment of tumor prostheses infection. Eur J Orthop Surg Traumatol. 2020;30(8):1345-1353.
  33. Fiore M, Sambri A, Zucchini R, Giannini C, Donati DM, De Paolis M. Silver-coated megaprosthesis in prevention and treatment of peri-prosthetic infections: a systematic review and meta-analysis about efficacy and toxicity in primary and revision surgery. Eur J Orthop Surg Traumatol. 2021;31(2):201-220.
  34. Parry MC, Laitinen MK, Albergo JI, Gaston CL, Stevenson JD, Grimer RJ, et al. Silver-coated (Agluna®) tumour prostheses can be a protective factor against infection in high risk failure patients. Eur J Surg Oncol. 2019;45(4):704-710.
  35. Scoccianti G, Frenos F, Beltrami G, Campanacci DA, Capanna R. Levels of silver ions in body fluids and clinical results in silver-coated megaprostheses after tumour, trauma or failed arthroplasty. Injury. 2016;47 Suppl 4:S11-S16.
  36. Wafa H, Grimer RJ, Reddy K, Jeys L, Abudu A, Carter SR, et al. Retrospective evaluation of the incidence of early periprosthetic infection with silver-treated endoprostheses in high-risk patients: case-control study. Bone Joint J. 2015;97-B(2):252-7.
  37. Zajonz D, Birke U, Ghanem M, Prietzel T, Josten C, Roth A, et al. Silver-coated modular Megaendoprostheses in salvage revision arthroplasty after periimplant infection with extensive bone loss - a pilot study of 34 patients. BMC Musculoskelet Disord. 2017;18(1):383.