Silver-coated megaprosthesis in prevention and treatment of peri-prosthetic infections: a systematic review and meta-analysis about efficacy and toxicity in primary and revision surgery
Aim Prosthetic joint infection (PJI) is a common complication following orthopedic megaprosthetic implantations (EPR), estimated up to 50%. Silver coatings were introduced in order to reduce the incidence of PJI, by using the antibacterial activity of silver. Three different silver coatings are avai...
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| Veröffentlicht in: | European journal of orthopaedic surgery & traumatology 2021-02, Vol.31 (2), p.201-220 |
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| creator | Fiore, Michele Sambri, Andrea Zucchini, Riccardo Giannini, Claudio Donati, Davide Maria De Paolis, Massimiliano |
| description | Aim
Prosthetic joint infection (PJI) is a common complication following orthopedic megaprosthetic implantations (EPR), estimated up to 50%. Silver coatings were introduced in order to reduce the incidence of PJI, by using the antibacterial activity of silver. Three different silver coatings are available: MUTARS
®
(Implantcast), Agluna
®
(Accentus Medical), PorAg
®
(Waldemar Link). The aim of this review is to provide an overview on efficacy and safety of silver-coated EPR both in primary and revision surgery, comparing infection rate according to the type of implant.
Methods
Through an electronic systematic search, we reviewed the articles concerning silver-coated EPRs. Infection rate, silver-related complications, local and blood concentrations of the silver were evaluated. Meta-analyses were performed to compare results from each study included.
Results
Nineteen studies were included. The overall infection rate in patients with silver-coated implants was 17.6% (133/755). Overall infection rate in primary silver-coated EPR was been 9.2% (44/445), compared to 11.2% (57/507) of non-silver-coated implants. The overall infection rate after revisions was 13.7% (25/183) in patients with silver-coated EPR and 29.2% (47/161) when uncoated EPR were used, revealing a strength statistically significative utility of silver coatings in preventing infections in this group (
p
: 0.019). Generally, the use of MUTARS
®
EPR had produced an almost constant decrease in the incidence of primary PJI but there are few data on the effectiveness in revisions. The results from the use of Agluna
®
in both primary and revisions implants are inconstant. Conversely, PorAg
®
had proven to be effective both in PJI prevention but, especially, when used in PJI revision settings. Local argyria was reported in 8 out of 357 patients (2.2%), while no systemic complications were described. Local and blood concentrations of silver were always reported very far to the threshold of toxicity, with the lowest concentration found using PorAg
®
.
Conclusions
Silver-coated EPRs are safe and effective in reduction in PJI and re-infection rate, in particular when used in higher risk patients and after two-stage revisions to fight PJI. |
| doi_str_mv | 10.1007/s00590-020-02779-z |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2440468375</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2488035637</sourcerecordid><originalsourceid>FETCH-LOGICAL-c441t-9487d17b44ba05a234ff45ce415ecd3ca116f32d390d98d4beafae1b58fb95cc3</originalsourceid><addsrcrecordid>eNp9kctu1TAQhi0EoqXwAiyQJTZsDHZsJw47VHGTKrEA1tbEGRdXuRxspyV9M94OpzmAxIKFZWvmm3888xPyVPCXgvPmVeJct5zxajtN07Lbe-RUKFkxwWtzv7xrKZnhtT4hj1K64lzoVuiH5ERWxrR1U52Sn5_DcI2RuRky9nTESzjEOeVvmEKiYaKHiNc45TBPFKae5oiQxxKgs6cHjIEd8RxcwT26DU2vKdC0powjbImiEfDmTmDEDAwmGNatAXTzkil6Hxy4de8w_wgu5HVvHkaIe3zTSNs30hIvMa6PyQMPQ8Inx_uMfH339sv5B3bx6f3H8zcXzCklMmuVaXrRdEp1wDVUUnmvtEMlNLpeOhCi9rLqZcv71vSqQ_CAotPGd612Tp6RF7tuGfT7ginbMSSHwwATzkuylVJc1UY2uqDP_0Gv5iWWWTfKGC51LZtCVTvlyuZSRG-PY1rB7Was3Y21xVh7Z6y9LUXPjtJLN2L_p-S3kwWQO5BKaioL-tv7P7K_AHjutOk</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2488035637</pqid></control><display><type>article</type><title>Silver-coated megaprosthesis in prevention and treatment of peri-prosthetic infections: a systematic review and meta-analysis about efficacy and toxicity in primary and revision surgery</title><source>Springer Nature - Complete Springer Journals</source><creator>Fiore, Michele ; Sambri, Andrea ; Zucchini, Riccardo ; Giannini, Claudio ; Donati, Davide Maria ; De Paolis, Massimiliano</creator><creatorcontrib>Fiore, Michele ; Sambri, Andrea ; Zucchini, Riccardo ; Giannini, Claudio ; Donati, Davide Maria ; De Paolis, Massimiliano</creatorcontrib><description>Aim
Prosthetic joint infection (PJI) is a common complication following orthopedic megaprosthetic implantations (EPR), estimated up to 50%. Silver coatings were introduced in order to reduce the incidence of PJI, by using the antibacterial activity of silver. Three different silver coatings are available: MUTARS
®
(Implantcast), Agluna
®
(Accentus Medical), PorAg
®
(Waldemar Link). The aim of this review is to provide an overview on efficacy and safety of silver-coated EPR both in primary and revision surgery, comparing infection rate according to the type of implant.
Methods
Through an electronic systematic search, we reviewed the articles concerning silver-coated EPRs. Infection rate, silver-related complications, local and blood concentrations of the silver were evaluated. Meta-analyses were performed to compare results from each study included.
Results
Nineteen studies were included. The overall infection rate in patients with silver-coated implants was 17.6% (133/755). Overall infection rate in primary silver-coated EPR was been 9.2% (44/445), compared to 11.2% (57/507) of non-silver-coated implants. The overall infection rate after revisions was 13.7% (25/183) in patients with silver-coated EPR and 29.2% (47/161) when uncoated EPR were used, revealing a strength statistically significative utility of silver coatings in preventing infections in this group (
p
: 0.019). Generally, the use of MUTARS
®
EPR had produced an almost constant decrease in the incidence of primary PJI but there are few data on the effectiveness in revisions. The results from the use of Agluna
®
in both primary and revisions implants are inconstant. Conversely, PorAg
®
had proven to be effective both in PJI prevention but, especially, when used in PJI revision settings. Local argyria was reported in 8 out of 357 patients (2.2%), while no systemic complications were described. Local and blood concentrations of silver were always reported very far to the threshold of toxicity, with the lowest concentration found using PorAg
®
.
Conclusions
Silver-coated EPRs are safe and effective in reduction in PJI and re-infection rate, in particular when used in higher risk patients and after two-stage revisions to fight PJI.</description><identifier>ISSN: 1633-8065</identifier><identifier>EISSN: 1432-1068</identifier><identifier>DOI: 10.1007/s00590-020-02779-z</identifier><identifier>PMID: 32889672</identifier><language>eng</language><publisher>Paris: Springer Paris</publisher><subject>General Review ; Infections ; Medicine ; Medicine & Public Health ; Meta-analysis ; Prostheses ; Surgery ; Surgical Orthopedics ; Systematic review ; Titanium alloys ; Transplants & implants ; Traumatic Surgery</subject><ispartof>European journal of orthopaedic surgery & traumatology, 2021-02, Vol.31 (2), p.201-220</ispartof><rights>Springer-Verlag France SAS, part of Springer Nature 2020</rights><rights>Springer-Verlag France SAS, part of Springer Nature 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c441t-9487d17b44ba05a234ff45ce415ecd3ca116f32d390d98d4beafae1b58fb95cc3</citedby><cites>FETCH-LOGICAL-c441t-9487d17b44ba05a234ff45ce415ecd3ca116f32d390d98d4beafae1b58fb95cc3</cites><orcidid>0000-0003-0546-670X</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1007/s00590-020-02779-z$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1007/s00590-020-02779-z$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,776,780,27901,27902,41464,42533,51294</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32889672$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Fiore, Michele</creatorcontrib><creatorcontrib>Sambri, Andrea</creatorcontrib><creatorcontrib>Zucchini, Riccardo</creatorcontrib><creatorcontrib>Giannini, Claudio</creatorcontrib><creatorcontrib>Donati, Davide Maria</creatorcontrib><creatorcontrib>De Paolis, Massimiliano</creatorcontrib><title>Silver-coated megaprosthesis in prevention and treatment of peri-prosthetic infections: a systematic review and meta-analysis about efficacy and toxicity in primary and revision surgery</title><title>European journal of orthopaedic surgery & traumatology</title><addtitle>Eur J Orthop Surg Traumatol</addtitle><addtitle>Eur J Orthop Surg Traumatol</addtitle><description>Aim
Prosthetic joint infection (PJI) is a common complication following orthopedic megaprosthetic implantations (EPR), estimated up to 50%. Silver coatings were introduced in order to reduce the incidence of PJI, by using the antibacterial activity of silver. Three different silver coatings are available: MUTARS
®
(Implantcast), Agluna
®
(Accentus Medical), PorAg
®
(Waldemar Link). The aim of this review is to provide an overview on efficacy and safety of silver-coated EPR both in primary and revision surgery, comparing infection rate according to the type of implant.
Methods
Through an electronic systematic search, we reviewed the articles concerning silver-coated EPRs. Infection rate, silver-related complications, local and blood concentrations of the silver were evaluated. Meta-analyses were performed to compare results from each study included.
Results
Nineteen studies were included. The overall infection rate in patients with silver-coated implants was 17.6% (133/755). Overall infection rate in primary silver-coated EPR was been 9.2% (44/445), compared to 11.2% (57/507) of non-silver-coated implants. The overall infection rate after revisions was 13.7% (25/183) in patients with silver-coated EPR and 29.2% (47/161) when uncoated EPR were used, revealing a strength statistically significative utility of silver coatings in preventing infections in this group (
p
: 0.019). Generally, the use of MUTARS
®
EPR had produced an almost constant decrease in the incidence of primary PJI but there are few data on the effectiveness in revisions. The results from the use of Agluna
®
in both primary and revisions implants are inconstant. Conversely, PorAg
®
had proven to be effective both in PJI prevention but, especially, when used in PJI revision settings. Local argyria was reported in 8 out of 357 patients (2.2%), while no systemic complications were described. Local and blood concentrations of silver were always reported very far to the threshold of toxicity, with the lowest concentration found using PorAg
®
.
Conclusions
Silver-coated EPRs are safe and effective in reduction in PJI and re-infection rate, in particular when used in higher risk patients and after two-stage revisions to fight PJI.</description><subject>General Review</subject><subject>Infections</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Meta-analysis</subject><subject>Prostheses</subject><subject>Surgery</subject><subject>Surgical Orthopedics</subject><subject>Systematic review</subject><subject>Titanium alloys</subject><subject>Transplants & implants</subject><subject>Traumatic Surgery</subject><issn>1633-8065</issn><issn>1432-1068</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>BENPR</sourceid><recordid>eNp9kctu1TAQhi0EoqXwAiyQJTZsDHZsJw47VHGTKrEA1tbEGRdXuRxspyV9M94OpzmAxIKFZWvmm3888xPyVPCXgvPmVeJct5zxajtN07Lbe-RUKFkxwWtzv7xrKZnhtT4hj1K64lzoVuiH5ERWxrR1U52Sn5_DcI2RuRky9nTESzjEOeVvmEKiYaKHiNc45TBPFKae5oiQxxKgs6cHjIEd8RxcwT26DU2vKdC0powjbImiEfDmTmDEDAwmGNatAXTzkil6Hxy4de8w_wgu5HVvHkaIe3zTSNs30hIvMa6PyQMPQ8Inx_uMfH339sv5B3bx6f3H8zcXzCklMmuVaXrRdEp1wDVUUnmvtEMlNLpeOhCi9rLqZcv71vSqQ_CAotPGd612Tp6RF7tuGfT7ginbMSSHwwATzkuylVJc1UY2uqDP_0Gv5iWWWTfKGC51LZtCVTvlyuZSRG-PY1rB7Was3Y21xVh7Z6y9LUXPjtJLN2L_p-S3kwWQO5BKaioL-tv7P7K_AHjutOk</recordid><startdate>20210201</startdate><enddate>20210201</enddate><creator>Fiore, Michele</creator><creator>Sambri, Andrea</creator><creator>Zucchini, Riccardo</creator><creator>Giannini, Claudio</creator><creator>Donati, Davide Maria</creator><creator>De Paolis, Massimiliano</creator><general>Springer Paris</general><general>Springer Nature B.V</general><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>KB0</scope><scope>M0S</scope><scope>NAPCQ</scope><scope>PHGZM</scope><scope>PHGZT</scope><scope>PKEHL</scope><scope>PPXIY</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope><orcidid>https://orcid.org/0000-0003-0546-670X</orcidid></search><sort><creationdate>20210201</creationdate><title>Silver-coated megaprosthesis in prevention and treatment of peri-prosthetic infections: a systematic review and meta-analysis about efficacy and toxicity in primary and revision surgery</title><author>Fiore, Michele ; Sambri, Andrea ; Zucchini, Riccardo ; Giannini, Claudio ; Donati, Davide Maria ; De Paolis, Massimiliano</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c441t-9487d17b44ba05a234ff45ce415ecd3ca116f32d390d98d4beafae1b58fb95cc3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>General Review</topic><topic>Infections</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Meta-analysis</topic><topic>Prostheses</topic><topic>Surgery</topic><topic>Surgical Orthopedics</topic><topic>Systematic review</topic><topic>Titanium alloys</topic><topic>Transplants & implants</topic><topic>Traumatic Surgery</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Fiore, Michele</creatorcontrib><creatorcontrib>Sambri, Andrea</creatorcontrib><creatorcontrib>Zucchini, Riccardo</creatorcontrib><creatorcontrib>Giannini, Claudio</creatorcontrib><creatorcontrib>Donati, Davide Maria</creatorcontrib><creatorcontrib>De Paolis, Massimiliano</creatorcontrib><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Nursing & Allied Health Database (Alumni Edition)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest Central (New)</collection><collection>ProQuest One Academic (New)</collection><collection>ProQuest One Academic Middle East (New)</collection><collection>ProQuest One Health & Nursing</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>European journal of orthopaedic surgery & traumatology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Fiore, Michele</au><au>Sambri, Andrea</au><au>Zucchini, Riccardo</au><au>Giannini, Claudio</au><au>Donati, Davide Maria</au><au>De Paolis, Massimiliano</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Silver-coated megaprosthesis in prevention and treatment of peri-prosthetic infections: a systematic review and meta-analysis about efficacy and toxicity in primary and revision surgery</atitle><jtitle>European journal of orthopaedic surgery & traumatology</jtitle><stitle>Eur J Orthop Surg Traumatol</stitle><addtitle>Eur J Orthop Surg Traumatol</addtitle><date>2021-02-01</date><risdate>2021</risdate><volume>31</volume><issue>2</issue><spage>201</spage><epage>220</epage><pages>201-220</pages><issn>1633-8065</issn><eissn>1432-1068</eissn><abstract>Aim
Prosthetic joint infection (PJI) is a common complication following orthopedic megaprosthetic implantations (EPR), estimated up to 50%. Silver coatings were introduced in order to reduce the incidence of PJI, by using the antibacterial activity of silver. Three different silver coatings are available: MUTARS
®
(Implantcast), Agluna
®
(Accentus Medical), PorAg
®
(Waldemar Link). The aim of this review is to provide an overview on efficacy and safety of silver-coated EPR both in primary and revision surgery, comparing infection rate according to the type of implant.
Methods
Through an electronic systematic search, we reviewed the articles concerning silver-coated EPRs. Infection rate, silver-related complications, local and blood concentrations of the silver were evaluated. Meta-analyses were performed to compare results from each study included.
Results
Nineteen studies were included. The overall infection rate in patients with silver-coated implants was 17.6% (133/755). Overall infection rate in primary silver-coated EPR was been 9.2% (44/445), compared to 11.2% (57/507) of non-silver-coated implants. The overall infection rate after revisions was 13.7% (25/183) in patients with silver-coated EPR and 29.2% (47/161) when uncoated EPR were used, revealing a strength statistically significative utility of silver coatings in preventing infections in this group (
p
: 0.019). Generally, the use of MUTARS
®
EPR had produced an almost constant decrease in the incidence of primary PJI but there are few data on the effectiveness in revisions. The results from the use of Agluna
®
in both primary and revisions implants are inconstant. Conversely, PorAg
®
had proven to be effective both in PJI prevention but, especially, when used in PJI revision settings. Local argyria was reported in 8 out of 357 patients (2.2%), while no systemic complications were described. Local and blood concentrations of silver were always reported very far to the threshold of toxicity, with the lowest concentration found using PorAg
®
.
Conclusions
Silver-coated EPRs are safe and effective in reduction in PJI and re-infection rate, in particular when used in higher risk patients and after two-stage revisions to fight PJI.</abstract><cop>Paris</cop><pub>Springer Paris</pub><pmid>32889672</pmid><doi>10.1007/s00590-020-02779-z</doi><tpages>20</tpages><orcidid>https://orcid.org/0000-0003-0546-670X</orcidid></addata></record> |
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| issn | 1633-8065 1432-1068 |
| language | eng |
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| source | Springer Nature - Complete Springer Journals |
| subjects | General Review Infections Medicine Medicine & Public Health Meta-analysis Prostheses Surgery Surgical Orthopedics Systematic review Titanium alloys Transplants & implants Traumatic Surgery |
| title | Silver-coated megaprosthesis in prevention and treatment of peri-prosthetic infections: a systematic review and meta-analysis about efficacy and toxicity in primary and revision surgery |
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