Modular prosthesis with a silver coating for periarticular reconstruction in septic prosthetic and post-traumatic failures

Introduction Infection in orthopaedic surgery is a dreadful complication. Patients are often subjected to several surgeries with prolonged antibiotic treatment, and the risk of persistent infection and debilitating functional outcome is high. Often, a massive bone defect coexists, linked to the need to perform extensive debridement to remove necrotic or infected bone. The antimicrobial activity of silver ion has been known since ancient times (silver vases and cisterns for drinking water) and in recent years has been revived in everyday life (toothbrushes, underwear) as well as in medicine (wound dressings). Materials and methods Recently, we developed an evolution of the modular prosthesis MegasystemC (Waldemar Link, Hamburg, Germany) with a silver coating (PorAg) and, at our Centre, from June 2010 to February 2012 were operated on 10 patients with septic arthroplasty (4 cases, 2 hips and 2 knees) or septic meta-epiphyseal post-traumatic deformity or nonunion (5 cases, 1 proximal and 4 distal femur) and on a patient affected by an epithelioid hemangioendothelioma of the distal femur with a previous infected biopsy. One patient with subtrochanteric nonunion was subjected to only 1 surgery before resection and modular silver-coating prosthesis, while in all other cases the number of previous surgeries ranged from 3 to 8. In 7 cases the infection had resolved, while in 3 cases the infection was persistent (1 knee arthrodesis prosthesis as a results of septic knee megaprosthesis and the subtrochanteric nonunion) and it was decided to revise them one-stage. Results In 8 cases the reconstruction was performed with an articulating prosthetic joint (3 proximal femur and 5 knee megaprosthesis of the distal femur) and in 2 cases with a knee arthrodesis prosthesis. Monitoring of inflammatory markers (ESR, C-reactive protein, fibrinogen) showed resolution of the infection in all cases. Discussion From the clinical point of view, all patients were satisfied with surgery. Radiographically, there are no signs of loosening or periprosthetic bone resorption. Conclusions the preliminary results of such a limited group of patients are encouraging and demonstrate that the use of silver coating prosthesis may be indicated in the reconstructions of periarticular loss of substance in septic failures, making single-stage revision surgery safer.