Zajonz Dirk, Birke Undine, Ghanem Mohamed, Prietzel Torsten, Josten Christoph, Roth Andreas, Fakler Johannes K M
Department of Orthopaedic Surgery, Trauma Surgery and Plastic Surgery, University Hospital Leipzig, Liebigstrasse 20, D-04103, Leipzig, Germany.
ZESBO - Zentrum zur Erforschung der Stuetz- und Bewegungsorgane, Semmelweisstrasse 14, D-04103, Leipzig, Germany.
BMC Musculoskelet Disord. 2017 Sep 2;18(1):383. doi: 10.1186/s12891-017-1742-7.
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.
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).
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.
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.
感染后存在骨缺损的患者进行髋关节和膝关节置换，再感染率较高。在这一脆弱的患者群体中，预防再感染应被视为比功能和缺损修复更为重要。使用无菌植入物的银涂层作为感染预防措施已得到证实；然而，这些涂层在大型植入物的感染性再植入中的意义仍未得到充分研究。
在一项回顾性分析中，对34例下肢（股骨或胫骨）骨感染治愈后接受模块化大型内置假体治疗的患者进行了评估。一组14例患者（NSCG：非银涂层组）使用非银涂层植入物：MML München-Lübeck™模块化内置假体系统（AQ Implants，德国阿尔恩斯堡）或MUTARS®模块化通用肿瘤与翻修系统（Implantcast GmbH，德国布克斯泰胡德）。另一组20例患者（SCG：银涂层组）使用MUTARS®的银涂层系统。除了临床检查结果和患者病史，特别是再感染率外，还使用新活动评分（NMS，由帕克和帕尔默提出）评估患者的活动能力。
中位随访期为72个月，范围为6至267个月。失访率为5.8%。SCG组治愈后再感染率为40%（8/20），NSCG组为57%（8/1），p = 0.34；α = 0.05。SCG组再感染的平均时间为14个月（1至72个月），NSCG组为8个月（1至48个月）（p = 0.61；α = 0.05）。两组在NMS方面无差异。
通过这项回顾性分析可以确定，使用银涂层植入物可降低髋关节和膝关节周围假体关节感染（PJI）治愈后模块化大型内置假体的再感染率。使用银涂层植入物还可延迟再感染的时间。由于这一高度特定患者群体的病例数量较少，无法确定统计学意义。然而，可以推测在感染情况后使用银涂层于大型内置假体有积极效果。
