Silver-coated (PorAg ® ) endoprosthesis can be protective against reinfection in the treatment of tumor prostheses infection.

Introduction: We aim to evaluate the use of silver (PorAg ^® ) coated compared to uncoated prosthesis in two-stage revision for prosthetic joint infection (PJI) of distal femur and proximal tibia megaprosthesis in oncological patients.
Materials and Methods: In total, 68 patients were retrospectively evaluated. Median age was 30 years (range 14-83). In total, 29 patients were re-implanted with PorAg ^® prosthesis and 39 with uncoated prosthesis (Megasystem C ^® , Waldemar Link GmbH & Co. KG, Hamburg, Germany). All patients had PJI confirmed according to Musculoskeletal Infection Society (MSIS) criteria. In 10 cases, no microorganism was identified at the time of first-stage revision, but all had a sinus communicating with the prosthesis. Successful eradication of the infection was defined by the absence of clinical/serologic evidence of infection at 6 months after the second stage or at latest follow-up. Infection was again defined according to the MSIS criteria.
Results: At 3-year follow-up, estimated reinfection rate in the silver group was slightly lower than in uncoated EPR (10.3% vs. 17.5%, p = 0.104). Among reinfected patients, only one out of three patients (33%) in the silver group required an amputation compared to 80% in the nonsilver group (p = 0.047).
Conclusions: Our results show the efficacy of PorAg ^® coating in the two-stage revision of knee EPR. PorAg ^® -coated EPR may have possible advantages over this traditional strategy, in particular when applied to patients with a higher risk of reinfection.