Gregor Hauschild

Reduction of periprosthetic infection with silver-coated megaprostheses in patients with bone sarcoma.

The placement of megaprostheses in patients with bone sarcoma is associated with high rates of infection, despite prophylactic antibiotic administration. In individual cases, secondary amputation is unavoidable in the effort to cure infection.

Application of high-mobility-group-A proteins increases the proliferative activity of chondrocytes in vitro.

The low capability of self-repair in hyaline cartilage tissue and chondrocytes de-differentiating when grown in vitro (e.g., for tissue engineering approaches) limits articular cartilage repair. It has been shown that the embryonic architectural transcription factors of the high-mobility-group-A (HMGA) protein family affect the regulation of cell differentiation by influencing the state of cell chromatin and are involved in hyaline cartilage development by affecting the expression of chondrocyte-specific marker genes. Thus, the control of cartilage cell proliferation and differentiation by HMGA proteins promises to be an important aspect in cartilage tissue repair. To elucidate the effects on the proliferative activity of hyaline chondrocytes, HMGA proteins were recombinantly expressed, highly purified, and applied to porcine hyaline cartilage cells growing in in vitro monolayer cell culture. Direct application of HMGA1a, HMGA1b, and HMGA2 proteins onto porcine chondrocytes was shown to have a highly significant influence on cell proliferation. Greater proliferation of chondrocytes was achieved than in the untreated control group, indicating a promising approach to enhancing cartilage tissue repair.

Evaluation of Osseous Integration of PVD-Silver-Coated Hip Prostheses in a Canine Model

Infection associated with biomaterials used for orthopedic prostheses remains a serious complication in orthopedics, especially tumor surgery. Silver-coating of orthopedic (mega)prostheses proved its efficiency in reducing infections but has been limited to surface areas exposed to soft tissues due to concerns of silver inhibiting osseous integration of cementless stems. To close this gap in the bactericidal capacity of silver-coated orthopedic prostheses extension of the silver-coating on surface areas intended for osseous integration seems to be inevitable. Our study reports about a PVD- (physical-vapor-deposition-) silver-coated cementless stem in a canine model for the first time and showed osseous integration of a silver-coated titanium surface in vivo. Radiological, histological, and biomechanical analysis revealed a stable osseous integration of four of nine stems implanted. Silver trace elemental concentrations in serum did not exceed 1.82 parts per billion (ppb) and can be considered as nontoxic. Changes in liver and kidney functions associated with the silver-coating could be excluded by blood chemistry analysis. This was in accordance with very limited metal displacement from coated surfaces observed by laser ablation inductively coupled plasma-mass spectrometry (LA-ICP-MS) 12 months after implantation. In conclusion our results represent a step towards complete bactericidal silver-coating of orthopedic prostheses.

Silver-coated megaprostheses: review of the literature

Periprosthetic infection remains one of the most serious complications following megaendoprostheses. Despite a large number of preventive measures that have been introduced in recent years, it has not been possible to further reduce the rate of periprosthetic infection. With regard to metallic modification of implants, silver in particular has been regarded as highly promising, since silver particles combine a high degree of antimicrobial activity with a low level of human toxicity. This review provides an overview of the history of the use of silver as an antimicrobial agent, its mechanism of action, and its clinical application in the field of megaendoprosthetics. The benefits of silver-coated prostheses could not be confirmed until now. However, a large number of retrospective studies suggest that the rate of periprosthetic infections could be reduced by using silver-coated megaprostheses.

Cartilage replacement in dogs -- A preliminary investigation of colonization of ceramic matrices.

The objective of this study was to examine the behaviour of canine chondrocytes following colonisation of a beta-tricalcium phosphate (beta-TCP, Cerasorbâ, Curasan) matrix. In total, five of these cylinders were inoculated with 1.5 ml of cell suspension and subsequently incubated for about one week. In the second part of the experiment, another five Cerasorbâ cylinders were each studded with two cartilage chips of variable size and then incubated for about one week. The series of experiments were analyzed using cell staining and imaging techniques that included scanning electron microscopy. Cell migration onto the matrix was proven for both colonisation methods. It was observed that colonising the cylinders by pipetting cell suspension on them produced far better results, with respect to both growth rate and spreading of the cells, than did colonisation by studding with cartilage chips. A homogenous, surface-covering colonisation with predominantly living cells was demonstrated by scanning electron microscopy in the chondrocyte morphology. In comparison to cell-culture controls, there was a clearly better colonisation, with cells attached to both the materials primary grains and its micropores. The ceramic studied is well accepted by canine chondrocytes, and appears to be fundamentally well-suited as a matrix for bio-artificial bone-cartilage replacement. Additional qualitative analyses and a series of experiments aiming to accelerate cell proliferation are planned for subsequent studies.

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

BackgroundProximal 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.MethodsInfection 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.ResultsInfections 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.ConclusionUsing 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.