Silver-coated megaprostheses in the proximal femur in patients with sarcoma

Eur J Orthop Surg Traumatol. 2019 Jan;29(1):79-85. doi: 10.1007/s00590-018-2270-3. Epub 2018 Jun 20.


Background: Proximal femur replacements in patients with sarcoma are associated with high rates of infection. This study is the largest one comparing infection rates with titanium versus silver-coated megaprostheses in sarcoma patients.

Methods: Infection rates were assessed in 99 patients with proximal femur sarcoma who underwent placement of a titanium (n = 35) or silver-coated (n = 64) megaprosthesis. Treatments administered for infection were also analyzed.

Results: Infections occurred in 14.3% of patients in the titanium group, in comparison with 9.4% of those in the silver group, when the development of infection was the primary end point. The 5- and 10-year event-free survival rates for the prosthesis relative to the parameter of infection were 90% in the silver group and 83% in the titanium group. The overall infection rates were 10.9% in the silver group and 20% in the titanium group. Two patients each in the silver and titanium groups ultimately had to undergo amputation. The need for two-stage prosthesis exchanges (57.1% in the titanium group) declined to 14.3% in the silver group.

Conclusion: Using a silver-coated proximal femoral replacement nearly halved the overall infection rate. When infections occurred, it was usually possible to avoid two-stage prosthesis exchanges in the silver group.

Keywords: Bone neoplasms; Implantation; Prosthesis-related infections; Proximal femur; Sarcoma; Silver.

Publication types

  • Comparative Study

MeSH terms

  • Adolescent
  • Adult
  • Aged
  • Aged, 80 and over
  • Bone Neoplasms / surgery*
  • Child
  • Child, Preschool
  • Femur
  • Humans
  • Middle Aged
  • Prostheses and Implants / adverse effects*
  • Prosthesis Design
  • Prosthesis-Related Infections / etiology*
  • Prosthesis-Related Infections / prevention & control*
  • Prosthesis-Related Infections / surgery
  • Sarcoma / surgery*
  • Silver / therapeutic use*
  • Soft Tissue Neoplasms / surgery*
  • Time Factors
  • Titanium
  • Young Adult


  • Silver
  • Titanium