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Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 465 - 466
1 Jul 2010
Hardes J von Eiff C Streitbürger A Balke M Budny T Henrichs M Ahrens H
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The use of megaprostheses is accompanied with periprosthetic infection in up to 15% of cases. Among metals with antimicrobial activity, silver has raised the interest of investigators because of its good antimicrobial activity. The aim of this study was to determine the infection rate of silver-coated megaprostheses in comparision to uncoated titanium prostheses.

We prospectively identified 40 patients who were treated with a silver-coated proximal femur (n=17) or proximal tibia (n=23) replacement (Mutars®, Implantcast, Germany). Patients with a silver-coated tumor endoprosthesis were compared with 74 (proximal femur replacement n=33, proximal tibia n=41) retrospectively assessed patients with a titanium endoprosthesis regarding the number of infections.

In the titanium group a proximal femur replacement was associated with the highest infection rate (18.2%; time of infection in mean 15 months postoperatively). In the silver-group infection could be reduced to 5.9% (time of infection 12 months postoperatively). In patients with a proximal tibia replacement the infection rate could be reduced from 17.1% (time of infection in mean 28 months postoperatively) to 4.3% (time of infection 4 months postoperatively) in the silver group.

Regarding the final, successful treatment of infection it can be stated that in the silver group the patients could be treated either by intravenous antibiotics only or by a one-stage exchange of the prosthetic body. In the titanium group seven patients (53%) were treated by a two-stage reimplantation of the prosthesis, in 4 patients (31%) an amputation and in one patient rotationplasty was performed.

We conclude that silver-coated megaendoprostheses can reduce the risk of infection on a short-term followup. Importantly, minor revisions in the case of infection in patients with a silver-coated prostheses were more often successful. Further studies with more patients and a longer followup are necessary in order to evaluate the possible benefit of silver exactly.


Orthopaedic Proceedings
Vol. 92-B, Issue SUPP_III | Pages 466 - 466
1 Jul 2010
Dieckmann R Ahrens H Hardes J Budny T von Eiff C Gosheger G
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Megaendoprotheses are widely used in the reconstruction of large bone defects in orthopaedic tumour surgery. The major complications (up to 36%) are periprosthetic infections. Persisting periprosthetic infections lead to secondary amputation up to 37% of the cases. One underestimated reason for persisting infections are subpopulations of S. aureus called “small colony variants” (SCVs). Aim of this study was to evaluate that silver ions might prevent or cure a periprosthetic infection caused by SCVs.

For testing the antimicrobial activity of silver-coated titanium we used a technique introduced by Bechert et al. Therefore an adhesion and proliferation assay was performed with clinical isolates of S. aureus SCV (A22616/3). We tested the adhesion and proliferation properties of S aureus SCV on stainless steel (steel), Cobalt-Chrome-Molybdenum-alloy (CoCrMo), Titan-Aluminium-Vanadium-alloy (TiAlVa) and silver-coated Titan-Aluminium-Vanadium-alloy (scTiAlVa).

Adhesion of S. aureus SCV is significantly reduced on scTiAlVa vs. steel (p> 0001). We could also demonstrate that the proliferation rate of scTiAlVa vs. all tested materials is significant (p> 0001) lower.

We concluded that silver-coating has an effective antimicrobial activity against S. aureus SCVs. Thus silver-coated megaendoprostheses are a good prophylaxis against persisting infections caused by S. aureus SCVs.


Orthopaedic Proceedings
Vol. 87-B, Issue SUPP_III | Pages 249 - 249
1 Sep 2005
Faber C Stallmann H Lyaruu D Joosten U von Eiff C van Nieuw Amerongen A Wuisman P
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Introduction: Antimicrobial peptides (AMP) are a novel class of antimicrobial agents effective against among others MRSA in vitro. Previously, we reported the release of AMP Dhvar-5 and hLF1-11 from different bone cements(1,4). In this study we investigated the efficacy of calcium phosphate cement (Calcibon®) loaded with hLF1-11 for the treatment of MRSA osteomyelitis in vivo.

Materials and Methods: Osteomyelitis was induced in 14 rabbits by MRSA, as described by Norden et al.(2) After 3 weeks all animals were treated by a thorough local debridement and subsequent filling of the tibial cavity with Calcibon® bone cement. Six control animals received Calcibon® without additives and 8 animals received Calcibon® loaded with 50 mg hLFl-11 per g cement powder. Treatment outcome was analyzed by microbiology, radiology and histology after 3 weeks follow-up.

Results: The results are shown in table 1. The number of CFU per gram of bone were significantly lower in the 50 mg hLFl-11 group (median 3.0x103 CFU/g bone) compared to the control group (median 3.5xl06 CFU/g bone).

Conclusion: This study demonstrates that hLFl-11 has the ability to cure an existing MRSA osteomyelitis in 5 out of 8 animals. The data suggest that the antimicrobial peptide, hLFl-11 in Calcibon® is able to treat osteomyelitis in vivo.