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Silver-coated modular Megaendoprostheses in salvage revision arthroplasty after periimplant infection with extensive bone loss – a pilot study of 34 patients

BACKGROUND: Hip and knee replacements in patients with bone defects after infection correlates with high rates of reinfection. In this vulnerable patient population, the prevention of reinfection is to be considered superordinate to the functionality and defect bridging. The use of silver coating of...

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Autores principales: Zajonz, Dirk, Birke, Undine, Ghanem, Mohamed, Prietzel, Torsten, Josten, Christoph, Roth, Andreas, Fakler, Johannes K.M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5581473/
https://www.ncbi.nlm.nih.gov/pubmed/28865425
http://dx.doi.org/10.1186/s12891-017-1742-7
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author Zajonz, Dirk
Birke, Undine
Ghanem, Mohamed
Prietzel, Torsten
Josten, Christoph
Roth, Andreas
Fakler, Johannes K.M.
author_facet Zajonz, Dirk
Birke, Undine
Ghanem, Mohamed
Prietzel, Torsten
Josten, Christoph
Roth, Andreas
Fakler, Johannes K.M.
author_sort Zajonz, Dirk
collection PubMed
description BACKGROUND: Hip and knee replacements in patients with bone defects after infection correlates with high rates of reinfection. In this vulnerable patient population, the prevention of reinfection is to be considered superordinate to the functionality and defect bridging. The use of silver coating of aseptic implants as an infection prophylaxis is already proven; however, the significance of these coatings in septic reimplantation of large implants is still not sufficiently investigated. METHODS: In a retrospective analysis, 34 patients who have been treated with a modular mega-endoprosthesis after a cured bone infection of the lower limb (femur or tibia) have been evaluated. One group with 14 patients (NSCG: non silver- coated group) was supplied with the non silver- coated implants: MML München- Lübeck™ modular endoprosthesis system (AQ Implants, Ahrensburg, Germany) or MUTARS® Modular Universal Tumor And Revision System (Implantcast GmbH, Buxtehude, Germany). The other group with 20 patients (SCG: silver- coated group) was supplied with the silver- coated system of MUTARS®. In addition to the clinical findings and the patients’ histories, specifically the reinfection rates, the patients’ mobility was assessed using the New Mobility Score (NMS, by Parker and Palmer). RESULTS: The median follow-up period was 72 months, ranging from 6 to 267 months. The dropout rate was 5.8%. The reinfection rate after healed reinfection in SCG was 40% (8/20), in NSCG 57% (8/14), p = 0.34; α =0.05. The time for reinfection was, on average, 14 months (1–72 months) in SCG and 8 months (1–48 months) in the NSCG (p = 0.61; α =0.05). The two groups showed no differences in the NMS. CONCLUSION: With this retrospective analysis, it can be determined that the rate of reinfection of modular mega-endoprostheses on the hip and knee joint after healed periprosthetic joint infection (PJI) can be reduced by the use of silver coated implants. The time until reinfection can also be delayed by utilizing silver coated implants. Due to the low number of cases of this highly specific patient population, no statistical significance could be determined. A positive effect, however, can be assumed through the use of silver coatings in mega-endoprostheses after an infectious situation.
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spelling pubmed-55814732017-09-06 Silver-coated modular Megaendoprostheses in salvage revision arthroplasty after periimplant infection with extensive bone loss – a pilot study of 34 patients Zajonz, Dirk Birke, Undine Ghanem, Mohamed Prietzel, Torsten Josten, Christoph Roth, Andreas Fakler, Johannes K.M. BMC Musculoskelet Disord Research Article BACKGROUND: Hip and knee replacements in patients with bone defects after infection correlates with high rates of reinfection. In this vulnerable patient population, the prevention of reinfection is to be considered superordinate to the functionality and defect bridging. The use of silver coating of aseptic implants as an infection prophylaxis is already proven; however, the significance of these coatings in septic reimplantation of large implants is still not sufficiently investigated. METHODS: In a retrospective analysis, 34 patients who have been treated with a modular mega-endoprosthesis after a cured bone infection of the lower limb (femur or tibia) have been evaluated. One group with 14 patients (NSCG: non silver- coated group) was supplied with the non silver- coated implants: MML München- Lübeck™ modular endoprosthesis system (AQ Implants, Ahrensburg, Germany) or MUTARS® Modular Universal Tumor And Revision System (Implantcast GmbH, Buxtehude, Germany). The other group with 20 patients (SCG: silver- coated group) was supplied with the silver- coated system of MUTARS®. In addition to the clinical findings and the patients’ histories, specifically the reinfection rates, the patients’ mobility was assessed using the New Mobility Score (NMS, by Parker and Palmer). RESULTS: The median follow-up period was 72 months, ranging from 6 to 267 months. The dropout rate was 5.8%. The reinfection rate after healed reinfection in SCG was 40% (8/20), in NSCG 57% (8/14), p = 0.34; α =0.05. The time for reinfection was, on average, 14 months (1–72 months) in SCG and 8 months (1–48 months) in the NSCG (p = 0.61; α =0.05). The two groups showed no differences in the NMS. CONCLUSION: With this retrospective analysis, it can be determined that the rate of reinfection of modular mega-endoprostheses on the hip and knee joint after healed periprosthetic joint infection (PJI) can be reduced by the use of silver coated implants. The time until reinfection can also be delayed by utilizing silver coated implants. Due to the low number of cases of this highly specific patient population, no statistical significance could be determined. A positive effect, however, can be assumed through the use of silver coatings in mega-endoprostheses after an infectious situation. BioMed Central 2017-09-02 /pmc/articles/PMC5581473/ /pubmed/28865425 http://dx.doi.org/10.1186/s12891-017-1742-7 Text en © The Author(s). 2017 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Zajonz, Dirk
Birke, Undine
Ghanem, Mohamed
Prietzel, Torsten
Josten, Christoph
Roth, Andreas
Fakler, Johannes K.M.
Silver-coated modular Megaendoprostheses in salvage revision arthroplasty after periimplant infection with extensive bone loss – a pilot study of 34 patients
title Silver-coated modular Megaendoprostheses in salvage revision arthroplasty after periimplant infection with extensive bone loss – a pilot study of 34 patients
title_full Silver-coated modular Megaendoprostheses in salvage revision arthroplasty after periimplant infection with extensive bone loss – a pilot study of 34 patients
title_fullStr Silver-coated modular Megaendoprostheses in salvage revision arthroplasty after periimplant infection with extensive bone loss – a pilot study of 34 patients
title_full_unstemmed Silver-coated modular Megaendoprostheses in salvage revision arthroplasty after periimplant infection with extensive bone loss – a pilot study of 34 patients
title_short Silver-coated modular Megaendoprostheses in salvage revision arthroplasty after periimplant infection with extensive bone loss – a pilot study of 34 patients
title_sort silver-coated modular megaendoprostheses in salvage revision arthroplasty after periimplant infection with extensive bone loss – a pilot study of 34 patients
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5581473/
https://www.ncbi.nlm.nih.gov/pubmed/28865425
http://dx.doi.org/10.1186/s12891-017-1742-7
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