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Preventive Techniques of Bone Tumor Surgical Site Infection: Comparison
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Please note this is a comparison between Version 2 by Beatrix Zheng and Version 1 by Shinji Miwa.

The management of malignant bone tumors requires multidisciplinary interventions including chemotherapy, radiation therapy, and surgical tumor resection and reconstruction. Surgical site infection (SSI) is a serious complication in the treatment of malignant bone tumors. Compared to other orthopedic surgeries, the surgical treatment of malignant bone tumors is associated with higher rates of SSIs. In patients with SSIs, additional surgeries, long-term administrations of antibiotics, extended hospital stays, and the postponement of scheduled adjuvant treatments are required. Therefore, SSI may adversely affect functional and oncological outcomes. To improve surgical outcomes in patients with malignant bone tumors, preoperative risk assessments for SSIs, new preventive techniques against SSIs, and the optimal use of prophylactic antibiotics are often required. Previous reports have demonstrated that age, tumor site (pelvis and tibia), extended operative time, implant use, body mass index, leukocytopenia, and reconstruction procedures are associated with an increased risk for SSIs. Furthermore, prophylactic techniques, such as silver and iodine coatings on implants, have been developed and proven to be efficacious and safe in clinical studies.

  • bone tumor
  • surgical site infection
  • risk factors

1. Introduction

The treatment of malignant bone tumors requires multidisciplinary interventions such as surgical tumor resection, chemotherapy, and radiation therapy. After surgical tumor resection, most bone defects require reconstruction using endoprostheses, allografts, autografts, artificial bones, or distraction osteogenesis [1,2,3,4,5][1][2][3][4][5]. During the surgical treatment of malignant bone tumors, risk conditions such as soft-tissue defects, large implants, allografts, frozen or irradiated bone, and radiation-therapy- or chemotherapy-induced immunodeficiency may cause complications (including surgical site infection (SSI), the loosening and breakage of the implant, delayed union, and the fracture of the grafted bone). SSI is one of the most severe complications related to bone tumor surgeries. The incidence of SSI following malignant bone tumor surgery has been reported to be 3–10 times higher than that following general orthopedic surgery [6,7][6][7]. The incidence of SSI in patients who underwent orthopedic surgeries was reported as 0.2–4.2% [8,9,10,11,12,13][8][9][10][11][12][13]. The incidence of SSI in total hip arthroplasty was reported as 0.2% [13], whereas the incidences of SSI in spine surgeries were reported as 3.4–4.2% [10,12][10][12]. On the other hand, high incidences of SSI have been reported in patients with malignant bone tumors [14,15,16,17,18,19,20,21,22,23,24,25,26,27,28,29][14][15][16][17][18][19][20][21][22][23][24][25][26][27][28][29]. In patients who underwent megaprosthesis after malignant bone tumor resection, 9.3–20.4% of the patients had SSI [14,15][14][15]. SSI rates after biological reconstruction were reported as 11.9–13.5% [16,17][16][17]. In patients with SSI, additional treatments (such as the long-term administration of antibiotics, implant and grafted bone removal, debridement, irrigation, and reconstruction) are often required. Therefore, SSIs entail longer periods of hospitalization, functional deteriorations, excessive medical costs, and delays in the treatment course, which increase mortality [30,31,32][30][31][32].
During bone cancer surgery, surgical reconstruction of the bone, ligaments, tendons, nerves, and vessels requires a long operative time and biomaterials, which may increase the risk of SSIs. Therefore, a preoperative assessment of the risk of complications is needed, and appropriate surgical procedures and adjuvant treatments should be chosen based on the risks and benefits of the surgery. In addition to the rarity of malignant bone tumors, the diversity of tumor locations, surgical procedures, biomaterials, and neoadjuvant or adjuvant treatments makes it difficult to identify risk factors for SSI. However, several studies have demonstrated predictive factors for SSI in patients with bone tumors. Furthermore, new techniques of antibacterial coating on implants have been developed, and their usefulness has been reported.

2. Current Practices in the Prophylaxis of SSI and Emerging Techniques

Although perioperative intravenous antibiotics are commonly administered to prevent SSI, there are still controversies regarding antibiotic regimens that can effectively prevent SSI. At the International Consensus Meeting on Musculoskeletal Infection, there was no recommendation to adjust the type, dose, and duration of antibiotic prophylaxis in patients undergoing oncologic endoprosthetic reconstruction from that which is routinely administered in conventional total joint arthroplasty [64][33]. A meta-analysis showed that the rate of SSI after endoprosthetic reconstruction in the lower extremity was 10%, and that the postoperative use of prophylactic antibiotics for a period longer than 24 h decreased the risk of SSI [65][34]. Contrarily, Ghert et al. conducted the Prophylactic Antibiotic Regimens in Tumor Surgery (PARITY) trial to compare the effects of a 5-day postoperative intravenous antibiotics regimen with those of a 1-day regimen on the prevention of SSI and antibiotics-related adverse effects in patients who underwent tumor resection and endoprosthetic reconstruction of the lower extremity [66][35]. In this restudyearch, 604 patients were randomly allocated to either the 5-day regimen or the 1-day regimen group. The incidences of SSI in patients treated with the 5-day regimen and 1-day regimens were 15% and 17%, respectively (hazard ratio (HR) = 0.93, p = 0.73). The incidences of antibiotics-related adverse events in the 5-day regimen group and 1-day regimen group were 5% and 2%, respectively (HR = 3.24, p = 0.02). Although the randomized trial showed no significant benefits of a longer period of antibiotic administration, the duration of antibiotic use should be determined based on the risk of SSI in each case.
Bacteria generate biofilms on the surfaces of implants, and antibiotics cannot reach the bacteria through the biofilms. Most cases of infection around implants require the removal of the implants. Implant-related infections were significantly associated with amputation (OR = 24.0, p < 0.001) and worse functional outcomes (OR = 0.01, p < 0.001), and the success rate of infection treatment without the removal of the implant was only 4.5% [31]. Therefore, the prevention of infection on implant surfaces is required to reduce the risk of SSI in patients who undergo surgical treatment using implants. Recently, antibacterial coating techniques (such as silver coating, iodine coating, and antibiotics coating) have been developed (Table 31) [67[36][37][38][39],68,69,70], and some basic and clinical studies have proven the safety and efficacy of these various coating techniques [71][40]. These techniques are thought to reduce the social and economic burden of implant-related infections in orthopedic surgeries.
The antibacterial activity of silver mostly depends on its ability to interfere with bacterial cell membrane permeability and cellular metabolism [71][40]. Silver coatings have been used on tumor prostheses [72,73][41][42]. Fiore et al. conducted a meta-analysis on SSI in patients treated with silver-coated megaprostheses [74][43]. In this reestudyarch, the patients with the silver-coated megaprostheses had an infection rate of 9.2% after primary surgery, whereas the patients with uncoated megaprostheses had an infection rate of 11.2%. In contrast, the infection rate after revision megaprosthesis was 13.7% in patients with silver-coated megaprostheses and 29.2% in patients with uncoated megaprostheses (p = 0.019). This studyreearch suggests that the silver-coated megaprosthesis is effective in reducing the incidence of SSI in patients at a high risk of postoperative infection. In a retrospective study involving 51 patients with bone sarcoma who underwent megaprosthesis replacement, the infection rates in patients with silver-coated megaprostheses and control patients were found to be 6% and 18%, respectively (p = 0.062) [70][39]. In another retrospective case-control study, the clinical outcomes of silver-coated tumor prostheses in 85 patients were compared with 85 matched controls [67][36]. The infection rates in the silver-coating and control groups were 12% and 22%, respectively (p = 0.033). After debridement, antibiotics administration, and implant retention in patients with SSI, the success (infection control) rates in patients with silver-coated implants and control patients were 70% and 32%, respectively (p = 0.048). Parry et al. compared the clinical outcomes of silver-coated endoprostheses in 89 patients at high risk for SSI with the outcomes of non-silver-coated endoprostheses in 305 patients [75][44]. Although the silver-coated prosthesis group had a higher risk of SSI, no significant difference in infection rates was reported between the silver-coated endoprosthesis (12%) and uncoated endoprosthesis (8%) groups (p = 0.154). Although silver-coating seems to be effective in the prevention of SSI, it has some disadvantages, such as the cytotoxicity of silver ions to bone cells, the incomplete protection of the implant, and the high cost of the technique [76,77][45][46].
Povidone-iodine can be used as an electrolyte to form an adhesive porous anodic oxide (which retains the antibacterial properties of iodine) [78][47]. In basic research, an iodine coating showed a good antibiofilm effect, a long antibacterial effect, good osteoconductivity, and safety to human cells [78][47]. In clinical studies, iodine-coated titanium showed a preventive effect against SSI [68,69,78][37][38][47]. Tsuchiya et al. investigated the effect of iodine-coated implants in 222 patients with immune-compromised conditions or postoperative infection [69][38]. Iodine-coated implants were used to prevent infection in 158 patients and treat active infections in 64 patients. Among patients in whom iodine-coated implants were used to prevent infection, 1.9% developed acute infection. All patients with active infection could be treated successfully without implant removal. In their study, no cytotoxicity or adverse effects were observed. Shirai et al. investigated the effect of iodine-coated implants on the infection rates in patients who underwent tumor resection and reconstruction using tumor-bearing frozen autografts [79][48]. They reported that 10 of 62 (16%) patients treated with uncoated implants had deep infections, whereas only 1 of 38 (3%) patients treated with iodine-coated implants had a deep infection (p = 0.032). In another study investigating the predictive factors for SSI in patients who underwent malignant bone tumor resection and reconstruction, iodine-coated implants significantly reduced the risk of SSI (OR = 0.3) [26].
Although there are limited reports on the effectiveness of antibiotics-coated implants in patients with bone tumors, several reports exist on the effectiveness of these implants in the treatment of fractures [80,81][49][50]. Fuchs et al. reported that no implant-related infections were observed in 21 patients treated with gentamicin poly (D, L-lactide)-coated intramedullary nails for closed or open tibial fractures, except for one patient who had wound-healing difficulties [80][49]. Metsemakers et al. investigated clinical outcomes of gentamicin-coated intramedullary nails in 16 patients with open tibial fractures, including 11 acute fractures and 5 revision cases [81][50]. In their study, no patient had a deep infection after surgery using gentamicin-coated nails. However, four (25%) patients had nonunion. In a multicenter prospective study involving 99 patients with fresh tibial fractures or who underwent revision surgeries for nonunion, deep infection or osteomyelitis was observed in 7.2% of patients with fresh fractures and 8% of patients who underwent revision surgeries [82][51]. However, this technique has some disadvantages: its availability is limited only to patients with tibial defects, and its effect is reduced in the event of gentamicin resistance [71][40].
Table 31.
Antibacterial coating techniques for the prevention of SSI during bone tumor surgery.
Study N Groups Clinical Outcomes Ref.
Silver-coated endoprosthesis 170 Silver: 85

Uncoated: 85		 Infection rate: 11.8% in the silver-coated group and 22.4% in the control group (p = 0.033)

Success rate of DAIR: 70% in the silver-coated group and 31.6% in the control group (		p = 0.048) [67][36]
Silver-coated endoprosthesis in patients with sarcoma 125 Silver: 51

Uncoated: 74		 Infection rate: 5.9% in the silver-coated group and 17.6% in the titanium group (p = 0.062) [70][39]
Silver-coated endoprosthesis in patients with sarcoma or GCTB 394 Silver: 89

Uncoated: 305		 Infection rates: 12.4% in the silver-coated group and 7.5% in the non-silver group (p = 0.154) [75][44]
Silver-coated endoprosthesis in two-stage revision for PJI 68 Silver: 29Uncoated: 39 Reinfection rate: 10.3% in the silver-coated group and 17.5% in the uncoated group (p = 0.104) [83][52]
Silver-coated endoprosthesis in patients with proximal femur sarcoma 99 Silver: 64 patients

Uncoated: 35		 Infection rates: 9.4% in the silver-coated group and 14.3% in the uncoated group [84][53]
Silver-coated endoprosthesis in patients with sarcoma or giant-cell tumor in the proximal tibia 98 Silver: 56

Uncoated: 42		 Infection rates: 8.9% in the silver-coated group and 16.7% in the uncoated group (p = 0.247) [85][54]
Silver-coated megaprosthesis in the proximal femur 68 Silver: 38

Uncoated: 30		 Infection rates: 7.9% in the silver-coated group and 16.7% in the uncoated group [86][55]
Iodine-coated implant in patients with malignant bone tumor 100 Iodine: 38

Uncoated: 62		 Deep infection rates: 3% in iodine-coated implants and 16% in non-coated implants (p = 0.032) [79][48]
Iodine-coated implant

in patients with malignant bone tumor		 302 Iodine: 66

Uncoated: 236		 Iodine-coated implants reduced the risk of SSI (OR = 0.3, p = 0.039) [26]
PJI, prosthetic joint infection; GCTB, giant cell tumor of bone; DAIR, debridement, antibiotics, and implant retention; OR, odds ratio.

References

  1. Jeys, L.; Grimer, R. The long-term risks of infection and amputation with limb salvage surgery using endoprostheses. Recent Results Cancer Res. 2009, 179, 75–84.
  2. Tsuchiya, H.; Tomita, K.; Minematsu, K.; Mori, Y.; Asada, N.; Kitano, S. Limb salvage using distraction osteogenesis. A classification of the technique. J. Bone Jt. Surg. Br. 1997, 79, 403–411.
  3. Tsuchiya, H.; Wan, S.L.; Sakayama, K.; Yamamoto, N.; Nishida, H.; Tomita, K. Reconstruction using an autograft containing tumour treated by liquid nitrogen. J. Bone Jt. Surg. Br. 2005, 87, 218–225.
  4. Grimer, R.J. Surgical options for children with osteosarcoma. Lancet Oncol. 2005, 6, 85–92.
  5. Miwa, S.; Takeuchi, A.; Shirai, T.; Yamamoto, N.; Hayashi, K.; Nishida, H.; Kimura, H.; Igarashi, K.; Tsuchiya, H. Outcomes and complications of reconstruction using tumor-bearing frozen autografts in patients with metastatic bone tumors. Anticancer Res. 2014, 34, 5569–5577.
  6. Strony, J.; Brown, S.; Choong, P.; Ghert, M.; Jeys, L.; O’Donnell, R.J. Musculoskeletal Infection in Orthopaedic Oncology: Assessment of the 2018 International Consensus Meeting on Musculoskeletal Infection. J. Bone Jt. Surg. Am. 2019, 101, e107.
  7. Morii, T.; Morioka, H.; Ueda, T.; Araki, N.; Hashimoto, N.; Kawai, A.; Mochizuki, K.; Ichimura, S. Deep infection in tumor endoprosthesis around the knee: A multi-institutional study by the Japanese musculoskeletal oncology group. BMC Musculoskelet. Disord. 2013, 14, 51.
  8. Zhang, K.; Tian, Y.; Zhao, Y.; Tian, M.; Li, X.; Zhu, Y. Incidence and Risk Factors for Surgical Site Infection after Femoral Neck Fracture Surgery: An Observational Cohort Study of 2218 Patients. Biomed. Res. Int. 2022, 2022, 5456616.
  9. Meng, J.; Zhu, Y.; Li, Y.; Sun, T.; Zhang, F.; Qin, S.; Zhao, H. Incidence and risk factors for surgical site infection following elective foot and ankle surgery: A retrospective study. J. Orthop. Surg. Res. 2020, 15, 449.
  10. Pei, H.; Wang, H.; Chen, M.; Ma, L.; Liu, G.; Ding, W. Surgical site infection after posterior lumbar interbody fusion and instrumentation in patients with lumbar degenerative disease. Int. Wound J. 2021, 18, 608–615.
  11. Shapiro, L.M.; Graham, L.A.; Hawn, M.T.; Kamal, R.N. Quality Reporting Windows May Not Capture the Effects of Surgical Site Infections After Orthopaedic Surgery. J. Bone Jt. Surg. Am. 2022, 104, 1281–1291.
  12. Matsumoto, H.; Larson, E.L.; Warren, S.I.; Hammoor, B.T.; Bonsignore-Opp, L.; Troy, M.J.; Barrett, K.K.; Striano, B.M.; Li, G.; Terry, M.B.; et al. A Clinical Risk Model for Surgical Site Infection Following Pediatric Spine Deformity Surgery. J. Bone Jt. Surg. Am. 2022, 104, 364–375.
  13. Bourget-Murray, J.; Bansal, R.; Soroceanu, A.; Piroozfar, S.; Railton, P.; Johnston, K.; Johnson, A.; Powell, J. Assessment of risk factors for early-onset deep surgical site infection following primary total hip arthroplasty for osteoarthritis. J. Bone Jt. Infect. 2021, 6, 443–450.
  14. Staals, E.L.; Sambri, A.; Campanacci, D.A.; Muratori, F.; Leithner, A.; Gilg, M.M.; Gortzak, Y.; Van De Sande, M.; Dierselhuis, E.; Mascard, E.; et al. Expandable distal femur megaprosthesis: A European Musculoskeletal Oncology Society study on 299 cases. J. Surg. Oncol. 2020, 122, 760–765.
  15. Pala, E.; Trovarelli, G.; Calabro, T.; Angelini, A.; Abati, C.N.; Ruggieri, P. Survival of modern knee tumor megaprostheses: Failures, functional results, and a comparative statistical analysis. Clin. Orthop. Relat. Res. 2015, 473, 891–899.
  16. Lee, S.Y.; Jeon, D.G.; Cho, W.H.; Song, W.S.; Kim, B.S. Are Pasteurized Autografts Durable for Reconstructions After Bone Tumor Resections? Clin. Orthop. Relat. Res. 2018, 476, 1728–1737.
  17. Araki, Y.; Yamamoto, N.; Hayashi, K.; Takeuchi, A.; Miwa, S.; Igarashi, K.; Higuchi, T.; Abe, K.; Taniguchi, Y.; Yonezawa, H.; et al. Clinical outcomes of frozen autograft reconstruction for the treatment of primary bone sarcoma in adolescents and young adults. Sci. Rep. 2021, 11, 17291.
  18. Severyns, M.; Briand, S.; Waast, D.; Touchais, S.; Hamel, A.; Gouin, F. Postoperative infections after limb-sparing surgery for primary bone tumors of the pelvis: Incidence, characterization and functional impact. Surg. Oncol. 2017, 26, 171–177.
  19. Abudu, A.; Grimer, R.J.; Cannon, S.R.; Carter, S.R.; Sneath, R.S. Reconstruction of the hemipelvis after the excision of malignant tumours. Complications and functional outcome of prostheses. J. Bone Jt. Surg. Br. 1997, 79, 773–779.
  20. Jaiswal, P.K.; Aston, W.J.; Grimer, R.J.; Abudu, A.; Carter, S.; Blunn, G.; Briggs, T.W.; Cannon, S. Peri-acetabular resection and endoprosthetic reconstruction for tumours of the acetabulum. J. Bone Jt. Surg. Br. 2008, 90, 1222–1227.
  21. Aljassir, F.; Beadel, G.P.; Turcotte, R.E.; Griffin, A.M.; Bell, R.S.; Wunder, J.S.; Isler, M.H. Outcome after pelvic sarcoma resection reconstructed with saddle prosthesis. Clin. Orthop. Relat. Res. 2005, 438, 36–41.
  22. Cottias, P.; Jeanrot, C.; Vinh, T.S.; Tomeno, B.; Anract, P. Complications and functional evaluation of 17 saddle prostheses for resection of periacetabular tumors. J. Surg. Oncol. 2001, 78, 90–100.
  23. Ozaki, T.; Hillmann, A.; Bettin, D.; Wuisman, P.; Winkelmann, W. High complication rates with pelvic allografts. Experience of 22 sarcoma resections. Acta Orthop. Scand. 1996, 67, 333–338.
  24. Guo, W.; Li, D.; Tang, X.; Ji, T. Surgical treatment of pelvic chondrosarcoma involving periacetabulum. J. Surg. Oncol. 2010, 101, 160–165.
  25. Ham, S.J.; Schraffordt Koops, H.; Veth, R.P.H.; van Horn, J.R.; Eisma, W.H.; Hoekstra, H.J. External and internal hemipelvectomy for sarcomas of the pelvic girdle: Consequences of limb-salvage treatment. Eur. J. Surg. Oncol. (EJSO) 1997, 23, 540–546.
  26. Miwa, S.; Shirai, T.; Yamamoto, N.; Hayashi, K.; Takeuchi, A.; Tada, K.; Kajino, Y.; Higuchi, T.; Abe, K.; Aiba, H.; et al. Risk factors for surgical site infection after malignant bone tumor resection and reconstruction. BMC Cancer 2019, 19, 33.
  27. Angelini, A.; Drago, G.; Trovarelli, G.; Calabro, T.; Ruggieri, P. Infection after surgical resection for pelvic bone tumors: An analysis of 270 patients from one institution. Clin. Orthop. Relat. Res. 2014, 472, 349–359.
  28. Fujiwara, T.; Ogura, K.; Christ, A.; Bartelstein, M.; Kenan, S.; Fabbri, N.; Healey, J. Periacetabular reconstruction following limb-salvage surgery for pelvic sarcomas. J. Bone Oncol. 2021, 31, 100396.
  29. Wu, J.; Xie, K.; Luo, D.; Wang, L.; Wu, W.; Yan, M.; Ai, S.; Dai, K.; Hao, Y. Three-dimensional printing-based personalized limb salvage and reconstruction treatment of pelvic tumors. J. Surg. Oncol. 2021, 124, 420–430.
  30. Morii, T.; Morioka, H.; Ueda, T.; Araki, N.; Hashimoto, N.; Kawai, A.; Takeuchi, K.; Anazawa, U.; Mochizuki, K.; Ichimura, S. Functional analysis of cases of tumor endoprostheses with deep infection around the knee: A multi institutional study by the Japanese Musculoskeletal Oncology Group (JMOG). J. Orthop. Sci. 2013, 18, 605–612.
  31. Gaur, A.H.; Liu, T.; Knapp, K.M.; Daw, N.C.; Rao, B.N.; Neel, M.D.; Rodriguez-Galindo, C.; Brand, D.; Adderson, E.E. Infections in children and young adults with bone malignancies undergoing limb-sparing surgery. Cancer 2005, 104, 602–610.
  32. Busscher, H.J.; van der Mei, H.C.; Subbiahdoss, G.; Jutte, P.C.; van den Dungen, J.J.; Zaat, S.A.; Schultz, M.J.; Grainger, D.W. Biomaterial-associated infection: Locating the finish line in the race for the surface. Sci. Transl. Med. 2012, 4, 153rv10.
  33. Parvizi, J.; Gehrke, T. Proceedings of the Second International Consensus Meeting on Musculoskeletal Infection; Data Trace Publishing Company: Brooklandville, MD, USA, 2018.
  34. Racano, A.; Pazionis, T.; Farrokhyar, F.; Deheshi, B.; Ghert, M. High infection rate outcomes in long-bone tumor surgery with endoprosthetic reconstruction in adults: A systematic review. Clin. Orthop. Relat. Res. 2013, 471, 2017–2027.
  35. Prophylactic Antibiotic Regimens in Tumor Surgery, I.; Ghert, M.; Schneider, P.; Guyatt, G.; Thabane, L.; Velez, R.; O’Shea, T.; Randall, R.L.; Turcotte, R.; Wilson, D.; et al. Comparison of Prophylactic Intravenous Antibiotic Regimens After Endoprosthetic Reconstruction for Lower Extremity Bone Tumors: A Randomized Clinical Trial. JAMA Oncol. 2022, 8, 345–353.
  36. Wafa, H.; Grimer, R.J.; Reddy, K.; Jeys, L.; Abudu, A.; Carter, S.R.; Tillman, R.M. Retrospective evaluation of the incidence of early periprosthetic infection with silver-treated endoprostheses in high-risk patients: Case-control study. Bone Jt. J. 2015, 97, 252–257.
  37. Shirai, T.; Tsuchiya, H.; Terauchi, R.; Tsuchida, S.; Mizoshiri, N.; Mori, Y.; Takeuchi, A.; Hayashi, K.; Yamamoto, N.; Ikoma, K.; et al. A retrospective study of antibacterial iodine-coated implants for postoperative infection. Medicine 2019, 98, e17932.
  38. Tsuchiya, H.; Shirai, T.; Nishida, H.; Murakami, H.; Kabata, T.; Yamamoto, N.; Watanabe, K.; Nakase, J. Innovative antimicrobial coating of titanium implants with iodine. J. Orthop. Sci. 2012, 17, 595–604.
  39. Hardes, J.; von Eiff, C.; Streitbuerger, A.; Balke, M.; Budny, T.; Henrichs, M.P.; Hauschild, G.; Ahrens, H. Reduction of periprosthetic infection with silver-coated megaprostheses in patients with bone sarcoma. J. Surg. Oncol. 2010, 101, 389–395.
  40. Romano, C.L.; Tsuchiya, H.; Morelli, I.; Battaglia, A.G.; Drago, L. Antibacterial coating of implants: Are we missing something? Bone Jt. Res. 2019, 8, 199–206.
  41. Alt, V. Antimicrobial coated implants in trauma and orthopaedics-A clinical review and risk-benefit analysis. Injury 2017, 48, 599–607.
  42. Schmidt-Braekling, T.; Streitbuerger, A.; Gosheger, G.; Boettner, F.; Nottrott, M.; Ahrens, H.; Dieckmann, R.; Guder, W.; Andreou, D.; Hauschild, G.; et al. Silver-coated megaprostheses: Review of the literature. Eur. J. Orthop. Surg. Traumatol. 2017, 27, 483–489.
  43. Fiore, M.; Sambri, A.; Zucchini, R.; Giannini, C.; Donati, D.M.; De Paolis, M. 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. Eur. J. Orthop. Surg. Traumatol. 2021, 31, 201–220.
  44. Parry, M.C.; Laitinen, M.K.; Albergo, J.I.; Gaston, C.L.; Stevenson, J.D.; Grimer, R.J.; Jeys, L.M. Silver-coated (Agluna(R)) tumour prostheses can be a protective factor against infection in high risk failure patients. Eur. J. Surg. Oncol. 2019, 45, 704–710.
  45. Mijnendonckx, K.; Leys, N.; Mahillon, J.; Silver, S.; Van Houdt, R. Antimicrobial silver: Uses, toxicity and potential for resistance. Biometals 2013, 26, 609–621.
  46. Trentinaglia, M.T.; Van Der Straeten, C.; Morelli, I.; Logoluso, N.; Drago, L.; Romano, C.L. Economic Evaluation of Antibacterial Coatings on Healthcare Costs in First Year Following Total Joint Arthroplasty. J. Arthroplast. 2018, 33, 1656–1662.
  47. Shirai, T.; Shimizu, T.; Ohtani, K.; Zen, Y.; Takaya, M.; Tsuchiya, H. Antibacterial iodine-supported titanium implants. Acta Biomater. 2011, 7, 1928–1933.
  48. Shirai, T.; Tsuchiya, H.; Terauchi, R.; Tsuchida, S.; Mizoshiri, N.; Igarashi, K.; Miwa, S.; Takeuchi, A.; Kimura, H.; Hayashi, K.; et al. The outcomes of reconstruction using frozen autograft combined with iodine-coated implants for malignant bone tumors: Compared with non-coated implants. Jpn. J. Clin. Oncol. 2016, 46, 735–740.
  49. Fuchs, T.; Stange, R.; Schmidmaier, G.; Raschke, M.J. The use of gentamicin-coated nails in the tibia: Preliminary results of a prospective study. Arch. Orthop. Trauma Surg. 2011, 131, 1419–1425.
  50. Metsemakers, W.J.; Reul, M.; Nijs, S. The use of gentamicin-coated nails in complex open tibia fracture and revision cases: A retrospective analysis of a single centre case series and review of the literature. Injury 2015, 46, 2433–2437.
  51. Schmidmaier, G.; Kerstan, M.; Schwabe, P.; Sudkamp, N.; Raschke, M. Clinical experiences in the use of a gentamicin-coated titanium nail in tibia fractures. Injury 2017, 48, 2235–2241.
  52. Sambri, A.; Zucchini, R.; Giannini, C.; Zamparini, E.; Viale, P.; Donati, D.M.; De Paolis, M. Silver-coated (PorAg((R))) endoprosthesis can be protective against reinfection in the treatment of tumor prostheses infection. Eur. J. Orthop. Surg. Traumatol. 2020, 30, 1345–1353.
  53. Streitbuerger, A.; Henrichs, M.P.; Hauschild, G.; Nottrott, M.; Guder, W.; Hardes, J. Silver-coated megaprostheses in the proximal femur in patients with sarcoma. Eur. J. Orthop. Surg. Traumatol. 2019, 29, 79–85.
  54. Hardes, J.; Henrichs, M.P.; Hauschild, G.; Nottrott, M.; Guder, W.; Streitbuerger, A. Silver-Coated Megaprosthesis of the Proximal Tibia in Patients With Sarcoma. J. Arthroplast. 2017, 32, 2208–2213.
  55. Donati, F.; Di Giacomo, G.; D’Adamio, S.; Ziranu, A.; Careri, S.; Rosa, M.; Maccauro, G. Silver-Coated Hip Megaprosthesis in Oncological Limb Savage Surgery. Biomed. Res. Int. 2016, 2016, 9079041.
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