Comparative effectiveness of silver-coated implants in periprosthetic infection prevention: A systematic review and meta-analysis

Introduction: Despite the implementation of numerous preventive measures in recent years, the persistent challenge of periprosthetic infections remains. Among the various strategies, metallic modification of implants, particularly with silver, has emerged as a promising avenue. Silver's antimicrobial properties, coupled with its low human toxicity, render it an appealing option. However, ongoing debate surrounds its comparative efficacy in infection prevention when contrasted with titanium-coated prostheses.

Methods: The PubMed database was systematically searched up to March 2024. Studies in English that met predetermined inclusion/exclusion criteria and utilized "Megaprosthesis AND infection" and " silver-coated AND infection " as key terms were included. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guided the article selection process.

Results: From a pool of 1892 potential papers after literature screening, 11 studies with a total of 1419 patients were meticulously selected for analysis. Among these patients, 638 were treated with silver-coated implants, while 781 received titanium-coated implants, resulting in 166 recorded cases of infection. Remarkably, the infection rate stood at 9.2 % for the silver-coated group, contrasting with 13.4 % for the titanium-coated group. The subsequent analysis unveiled a notable discrepancy in proportions (P difference = -0.0473, 95 % CI: -0.088 to -0.006), signaling a statistically significant decrease in infections within the silver-coated cohort. Furthermore, the I2 statistic, denoting heterogeneity in effect sizes, stood at 21.8 % (95 % CI: 0.0-66.9), indicating a modest degree of variability among the studies. These findings offer compelling insights into the comparative effectiveness of silver-coated implants, suggesting their potential superiority in infection prevention.

Conclusion: In conclusion, our systematic review and meta-analysis shed light on the potential of silver-coated implants in mitigating periprosthetic infections. Despite the persistent challenge posed by such infections, our findings suggest a statistically significant decrease in infection rates among patients treated with silver-coated implants compared to those with titanium-coated ones.