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Are silver-coated megaprostheses superior to uncoated megaprostheses in managing chronic end-stage periprosthetic hip and knee infection?

  • Knee Revision Surgery
  • Published:
Archives of Orthopaedic and Trauma Surgery Aims and scope Submit manuscript

Abstract

Introduction

Outcomes for silver coated megaprostheses (SC-MP) used in cases of end-stage periprosthetic joint infection (PJI) have not been clearly defined. Although attractive, concerns over implant longevity and the risk of infection relapse exist among the scientific community. Therefore, we sought to investigate the effect of silver coating in lower-extremity MPs used in such difficult-to-treat scenarios. The study’s primary hypothesis was that the periprosthetic infection control rate would be higher in patients with silver-coated implants.

Materials and methods

Non-interventional retrospective study with a historical comparison group. We identified all consecutive end-stage hip and knee PJI cases at our center managed with exchange arthroplasty using a silver-coated megaprosthesis from January 2016 to March 2021, these cases were compared with a historical cohort of end-stage PJI cases managed with uncoated megaprostheses. The main outcome studied was infection control rate. Secondarily, we analyzed the short-to-medium-term survivorship of this type of silver-coated implant.

Results

Fifty-nine megaprostheses used in cases of end-stage PJI were included in this study. We identified 30 cases of chronic hip or knee PJI in which a silver-coated modular megaprosthesis was implanted. Our non-coated megaprosthesis (NC-MP) historical group included 29 patients. Both groups had similar demographic characteristics. We found no statistically significant differences in infection control rate (80% vs. 82.8%, p = 0.47) or implant survivorship (90% vs. 89.65%, p = 1) after a mean follow-up for SC-MP of 46.43 months, and 48 months for the non-coated MP group. In relapsed cases, there were no differences in infection eradication after DAIR (66% SC-MP vs. 60% NC-MP success rate, p = 1). During the follow-up we observed one case of skin argyria without further repercussion.

Conclusion

We were unable to confirm our initial hypothesis that use of silver-coated implants in end-stage PJI scenarios may be associated with better outcomes in terms of infection control or implant survivorship.

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Acknowledgements

We wish to thank Russell Williams of RoundlyWorded.com for his editorial recommendations. We further wish to thank our entire multidisciplinary team, including Dr. Carles Amat and Dr Lluis Carrera, members of the Septic and Reconstructive Surgery Unit; Dr. Jordi Serracanta, member of the Plastic Surgery Department, and Dr. Juan Carlos Juarez, a member of our center’s Pharmacy Department. I would also like to acknowledge the inestimable help of our infectious diseases team, with Dr. Carles Pigrau and Dr. Dolors Rodrigez-Pardo, without her help it would be far more difficult to operate on patients of this type.

Funding

This work received no outside financial support. The study was conducted as part of the routine work of our institution.

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Authors and Affiliations

  1. Septic and Reconstructive Surgery Unit, Orthopaedic Surgery Department, Vall d’Hebrón University Hospital, Universitat Autònoma de Barcelona, Pg. Vall d’Hebron 119-129, 08035, Barcelona, Spain

    Matías Vicente, Kushal Lakhani & Pablo S. Corona

  2. Musculoskeletal Tissue Engineering Group, Vall d’Hebron Research Institute, Barcelona, Spain

    Matías Vicente & Pablo S. Corona

  3. Universitat Autònoma de Barcelona, Barcelona, Spain

    Matías Vicente, Kushal Lakhani & Pablo S. Corona

  4. Orthopaedic Surgery Department, Vall d’Hebron University Hospital, Universitat Autònoma de Barcelona, Barcelona, Spain

    Josep Nomdedeu

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  1. Matías Vicente
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Correspondence to Matías Vicente.

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Conflict of interest

The author does not have any other conflict of interest with said companies. No author has had any relationships, or has engaged in any other activities that could be perceived to influence or have the potential to influence what is written in this work. The study was approved by the Ethics Committee of Vall d’Hebron Research Institute (VHIR- Institutional Review Board approval). All Authors: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

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Vicente, M., Nomdedeu, J., Lakhani, K. et al. Are silver-coated megaprostheses superior to uncoated megaprostheses in managing chronic end-stage periprosthetic hip and knee infection?. Arch Orthop Trauma Surg 144, 2197–2205 (2024). https://doi.org/10.1007/s00402-024-05244-2

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