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Modifications to implant surfaces found effective at mitigating infection
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BIRMINGHAM, England — With the number of revision total joint arthroplasty procedures performed in the United Kingdom due to infection increasing, an orthopaedic surgeon from Birmingham reported success fighting infection using implants specially coated with silver.
Lee M. Jeys, MSc(Orth)Eng, FRCS(Tr&Orth), said at the British Orthopaedic Association Annual Meeting that Stanmore Implants and Implantcasts, two manufacturers he is aware of, modify the surface of titanium orthopaedic implants by adding a thin layer of silver. About <1.0 mg silver also collects in reservoirs or pits that are specially created on the surface of the prostheses and it is then released over time to fight infection, he said.
"At the moment we are using silver-coated implants routinely for proximal tibia, pelvic hip implants, and for the revisions," said Jeys, who is at the Royal Orthopaedic Hospital in Birmingham.
In a study of 170 patients (106 men and 64 women) with a high risk of revision, 85 patients received a silver-coated implant, most of which were for distal femoral replacement. The patients were matched for age, location and type of surgery to patients who received a typical prosthesis, Jeys said. All patients had a minimum of 6 months follow-up.
Jeys and colleagues found an overall 12.9% risk of acute infection in the patients with the silver-coated implants and a 23.5% risk of infection for the patients with the usual prostheses.
"So it seemed to be statistically significant,” he said.
Furthermore, debridement, antibiotics and implant retention (DAIR) could be done more readily in the patients with the silver implants, according to Jeys.
In the series, about 73% of patients with the silver-coated implants had success with DAIR compared with 25% of patients with the regular implants.
"In our series, we haven't seen any evidence of local reaction [to the silver] due to the Stanmore implants," Jeys said.
Based on these results and the long-term implications of this approach for stemming future expenditures, he said the extra cost of silver-coated prostheses of 300 £ also seemed to be worth the added expenditure.
Reference:
Jeys LM. The infected endoprosthetic replacement. Presented at: British Orthopaedic Association Congress. Oct.1-4, 2013. Birmingham, England.
Disclosure: Orthopaedics Today Europe was unable to confirm Jeys’ relevant financial disclosures.