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.
Musculoskeletal Tissue Engineering Group, Vall d'Hebron Research Institute, Barcelona, Spain.
Arch Orthop Trauma Surg. 2024 May;144(5):2197-2205. doi: 10.1007/s00402-024-05244-2. Epub 2024 Mar 23.
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.
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.
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.
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.
在终末期假体周围关节感染（PJI）病例中使用银涂层的大型假体（SC-MP）的结果尚未明确界定。尽管具有吸引力，但科学界对植入物的长期耐用性和感染复发的风险存在担忧。因此，我们试图研究在这种难以治疗的情况下使用银涂层的下肢 MP 对假体周围感染的控制效果。该研究的主要假设是，在使用银涂层植入物的患者中，假体周围感染的控制率会更高。
这是一项非介入性回顾性研究，采用历史对照组。我们在 2016 年 1 月至 2021 年 3 月期间，在我们的中心发现所有使用银涂层大型假体进行的髋关节和膝关节终末期 PJI 置换术的连续病例，这些病例与使用未涂层大型假体治疗的终末期 PJI 病例的历史队列进行比较。主要研究结果是感染控制率。其次，我们分析了这种类型的银涂层植入物的中短期生存率。
本研究共纳入 59 例用于治疗终末期 PJI 的大型假体。我们发现 30 例慢性髋关节或膝关节 PJI 患者植入了银涂层模块化大型假体。我们的非涂层大型假体（NC-MP）历史组包括 29 名患者。两组的人口统计学特征相似。在平均随访 46.43 个月后，我们发现使用银涂层的大型假体（80%）与未涂层的大型假体（82.8%）的感染控制率（p=0.47）或植入物存活率（90% 对 89.65%）无统计学差异，对于非涂层 MP 组，随访时间为 48 个月。在复发的病例中，通过 DAIER 后的感染消除率无差异（SC-MP 组 66%，NC-MP 组 60%，p=1）。在随访过程中，我们观察到一例皮肤银质沉着症，无进一步影响。
我们无法证实我们最初的假设，即在终末期 PJI 情况下使用银涂层植入物可能与感染控制或植入物存活率方面的更好结果相关。
