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

  • Arne Streitbuerger
  • Marcel P. Henrichs
  • Gregor Hauschild
  • Markus Nottrott
  • Wiebke Guder
  • Jendrik Hardes
Original Article • HIP - TUMORS



Proximal femur replacements in patients with sarcoma are associated with high rates of infection. This study is the largest one comparing infection rates with titanium versus silver-coated megaprostheses in sarcoma patients.


Infection rates were assessed in 99 patients with proximal femur sarcoma who underwent placement of a titanium (n = 35) or silver-coated (n = 64) megaprosthesis. Treatments administered for infection were also analyzed.


Infections occurred in 14.3% of patients in the titanium group, in comparison with 9.4% of those in the silver group, when the development of infection was the primary end point. The 5- and 10-year event-free survival rates for the prosthesis relative to the parameter of infection were 90% in the silver group and 83% in the titanium group. The overall infection rates were 10.9% in the silver group and 20% in the titanium group. Two patients each in the silver and titanium groups ultimately had to undergo amputation. The need for two-stage prosthesis exchanges (57.1% in the titanium group) declined to 14.3% in the silver group.


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.


Prosthesis-related infections Bone neoplasms Silver Implantation Proximal femur Sarcoma 


Compliance with ethical standards

Ethical approval

Ethical approval was obtained from the local ethic committee of the University of Muenster.

Conflict of interest

Authors A.S., M.P.H., M.N., W.G. and J.H. declare that they have no conflict of interest. Author G.H. has a honorarium from Implantcast Company for scientific consulting and clinical reviewing.


  1. 1.
    Chandrasekar CR, Grimer RJ, Carter SR et al (2009) Modular endoprosthetic replacement for tumours of the proximal femur. J Bone Joint Surg Br 91:108–112CrossRefGoogle Scholar
  2. 2.
    Funovics PT, Hipfl C, Hofstaetter JG et al (2011) Management of septic complications following modular endoprosthetic reconstruction of the proximal femur. Int Orthop 35:1437–1444. CrossRefGoogle Scholar
  3. 3.
    Hardes J, Budny T, Hauschild G et al (2009) Proximal femur replacement in revision arthroplasty. Z Orthop Unfall 147:694–699CrossRefGoogle Scholar
  4. 4.
    Gosheger G, Gebert C, Ahrens H et al (2006) Endoprosthetic reconstruction in 250 patients with sarcoma. Clin Orthop 450:164–171CrossRefGoogle Scholar
  5. 5.
    Jeys LM, Kulkarni A, Grimer RJ et al (2008) Endoprosthetic reconstruction for the treatment of musculoskeletal tumors of the appendicular skeleton and pelvis. J Bone Joint Surg Am 90:1265–1271CrossRefGoogle Scholar
  6. 6.
    Hardes J, Gebert C, Schwappach A et al (2006) Characteristics and outcome of infections associated with tumor endoprostheses. Arch Orthop Trauma Surg 126:289–296CrossRefGoogle Scholar
  7. 7.
    Kamath AF, Ong KL, Lau E et al (2015) Quantifying the burden of revision total joint arthroplasty for periprosthetic infection. J Arthroplasty 30:1492–1497. CrossRefGoogle Scholar
  8. 8.
    Hardes J, von Eiff C, Streitbuerger A et al (2010) Reduction of periprosthetic infection with silver-coated megaprostheses in patients with bone sarcoma. J Surg Oncol 101:389–395Google Scholar
  9. 9.
    Hardes J, Ahrens H, Gebert C et al (2007) Lack of toxicological side-effects in silver-coated megaprostheses in humans. Biomaterials 28:2869–2875CrossRefGoogle Scholar
  10. 10.
    Gosheger G, Hillmann A, Lindner N et al (2001) Soft tissue reconstruction of megaprostheses using a Trevira tube. Clin Orthop 393:264–271CrossRefGoogle Scholar
  11. 11.
    Parvizi J, Gehrke T, International Consensus Group on Periprosthetic Joint Infection (2014) Definition of periprosthetic joint infection. J Arthroplasty 29:1331. CrossRefGoogle Scholar
  12. 12.
    Racano A, Pazionis T, Farrokhyar F et al (2013) High infection rate outcomes in long-bone tumor surgery with endoprosthetic reconstruction in adults: a systematic review. Clin Orthop 471:2017–2027. CrossRefGoogle Scholar
  13. 13.
    Dale H, Fenstad AM, Hallan G et al (2012) Increasing risk of prosthetic joint infection after total hip arthroplasty. Acta Orthop 83:449–458. CrossRefGoogle Scholar
  14. 14.
    Calabro T, van Rooyen R, Piraino I et al (2016) Reconstruction of the proximal femur with a modular resection prosthesis. Eur J Orthop Surg Traumatol 26:415–421. CrossRefGoogle Scholar
  15. 15.
    Randall CP, Gupta A, Jackson N et al (2015) Silver resistance in Gram-negative bacteria: a dissection of endogenous and exogenous mechanisms. J Antimicrob Chemother 70:1037–1046. Google Scholar
  16. 16.
    Politano AD, Campbell KT, Rosenberger LH et al (2013) Use of silver in the prevention and treatment of infections: silver review. Surg Infect 14:8–20. CrossRefGoogle Scholar
  17. 17.
    Dahlberg PJ, Agger WA, Singer JR et al (1995) Subclavian hemodialysis catheter infections: a prospective, randomized trial of an attachable silver-impregnated cuff for prevention of catheter-related infections. Infect Control Hosp Epidemiol 16:506–511CrossRefGoogle Scholar
  18. 18.
    Riley DK, Classen DC, Stevens LE et al (1995) A large randomized clinical trial of a silver-impregnated urinary catheter: lack of efficacy and staphylococcal superinfection. Am J Med 98:349–356CrossRefGoogle Scholar
  19. 19.
    Tokmaji G, Vermeulen H, Müller MCA et al (2015) Silver-coated endotracheal tubes for prevention of ventilator-associated pneumonia in critically ill patients. Cochrane Database Syst Rev 8:CD009201. Google Scholar
  20. 20.
    Gosheger G, Hardes J, Ahrens H et al (2004) Silver-coated megaendoprostheses in a rabbit model—an analysis of the infection rate and toxicological side effects. Biomaterials 25:5547–5556CrossRefGoogle Scholar
  21. 21.
    Glehr M, Leithner A, Friesenbichler J et al (2013) Argyria following the use of silver-coated megaprostheses: no association between the development of local argyria and elevated silver levels. Bone Joint J 95-B:988–992. CrossRefGoogle Scholar
  22. 22.
    Wafa H, Grimer RJ, Reddy K et al (2015) Retrospective evaluation of the incidence of early periprosthetic infection with silver-treated endoprostheses in high-risk patients: case-control study. Bone Joint J 97-B:252–257. CrossRefGoogle Scholar
  23. 23.
    Schierholz JM, Lucas LJ, Rump A et al (1998) Efficacy of silver-coated medical devices. J Hosp Infect 40:257–262CrossRefGoogle Scholar
  24. 24.
    Hauschild G, Hardes J, Gosheger G et al (2015) Evaluation of osseous integration of PVD-silver-coated hip prostheses in a canine model. Biomed Res Int 2015:292406. CrossRefGoogle Scholar
  25. 25.
    Jeys LM, Grimer RJ, Carter SR et al (2003) Risk of amputation following limb salvage surgery with endoprosthetic replacement, in a consecutive series of 1261 patients. Int Orthop 27:160–163Google Scholar
  26. 26.
    Jeys LM, Grimer RJ, Carter SR et al (2005) Periprosthetic infection in patients treated for an orthopaedic oncological condition. J Bone Joint Surg Am 87:842–849CrossRefGoogle Scholar

Copyright information

© Springer-Verlag France SAS, part of Springer Nature 2018

Authors and Affiliations

  • Arne Streitbuerger
    • 1
    • 2
  • Marcel P. Henrichs
    • 3
  • Gregor Hauschild
    • 1
  • Markus Nottrott
    • 1
  • Wiebke Guder
    • 1
    • 2
  • Jendrik Hardes
    • 1
    • 2
  1. 1.Department of Orthopedics and Tumor OrthopedicsMünster University HospitalMünsterGermany
  2. 2.Department of Oncologic Musculoskeletal SurgeryEssen University HospitalEssenGermany
  3. 3.Department of OrthopedicsParacelsus ClinicOsnabrückGermany

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