Silver-coated (PorAg^®) endoprosthesis can be protective against reinfection in the treatment of tumor prostheses infection.

Abstract

We aim to evaluate the use of silver (PorAg^®) coated compared to uncoated prosthesis in two-stage revision for prosthetic joint infection (PJI) of distal femur and proximal tibia megaprosthesis in oncological patients. In total, 68 patients were retrospectively evaluated. Median age was 30 years (range 14-83). In total, 29 patients were re-implanted with PorAg^® prosthesis and 39 with uncoated prosthesis (Megasystem C^®, Waldemar Link GmbH & Co. KG, Hamburg, Germany). All patients had PJI confirmed according to Musculoskeletal Infection Society (MSIS) criteria. In 10 cases, no microorganism was identified at the time of first-stage revision, but all had a sinus communicating with the prosthesis. Successful eradication of the infection was defined by the absence of clinical/serologic evidence of infection at 6 months after the second stage or at latest follow-up. Infection was again defined according to the MSIS criteria. At 3-year follow-up, estimated reinfection rate in the silver group was slightly lower than in uncoated EPR (10.3% vs. 17.5%, p = 0.104). Among reinfected patients, only one out of three patients (33%) in the silver group required an amputation compared to 80% in the nonsilver group (p = 0.047). Our results show the efficacy of PorAg^® coating in the two-stage revision of knee EPR. PorAg^®-coated EPR may have possible advantages over this traditional strategy, in particular when applied to patients with a higher risk of reinfection.