Streitbuerger Arne, Henrichs Marcel P, Hauschild Gregor, Nottrott Markus, Guder Wiebke, Hardes Jendrik
Department of Orthopedics and Tumor Orthopedics, Münster University Hospital, Münster, Germany.
Department of Oncologic Musculoskeletal Surgery, Essen University Hospital, Hufelandstr. 55, 45147, Essen, Germany.
Eur J Orthop Surg Traumatol. 2019 Jan;29(1):79-85. doi: 10.1007/s00590-018-2270-3. Epub 2018 Jun 20.
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.
肉瘤患者的股骨近端置换术感染率较高。本研究是比较肉瘤患者使用钛合金与镀银假体感染率的规模最大的一项研究。
对99例行股骨近端肉瘤切除术并植入钛合金假体（n = 35）或镀银假体（n = 64）的患者的感染率进行评估。同时分析针对感染所采取的治疗措施。
以感染发生情况作为主要终点指标时，钛合金组患者的感染率为14.3%，而镀银组为9.4%。相对于感染参数，镀银组假体的5年和10年无事件生存率为90%，钛合金组为83%。镀银组的总体感染率为10.9%，钛合金组为20%。镀银组和钛合金组各有2例患者最终不得不接受截肢手术。钛合金组二期假体置换的需求率为57.1%，而镀银组降至14.3%。
使用镀银的股骨近端置换假体可使总体感染率降低近一半。当发生感染时，镀银组通常可避免二期假体置换。
