Hindawi Publishing Corporation BioMed Research International Volume 2013, Article ID 763096, 11 pages http://dx.doi.org/10.1155/2013/763096 Clinical Study Measurement of the Silver Ion Concentration in Wound Fluids after Implantation of Silver-Coated Megaprostheses: Correlation with the Clinical Outcome B. Hussmann, 1 I. Johann, 1 M. D. Kauther, 1 S. Landgraeber, 2 Marcus Jäger, 1,2 and S. Lendemans 1 1 Trauma Surgery Department, University Hospital Essen, Hufelandstraße 55, 45122 Essen, Germany 2 Orthopaedic Department, University of Duisburg-Essen, Hufelandstraße 55, 45122 Essen, Germany Correspondence should be addressed to B. Hussmann; bjoern.hussmann@uk-essen.de Received 1 April 2013; Accepted 15 May 2013 Academic Editor: Kurt G. Naber Copyright © 2013 B. Hussmann et al. his is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. Background. Tumor patients and patients ater traumas are endangered by a reduced immune defense, and a silver coating on their megaprostheses may reduce their risks of infection. he aim of this study was to determine the silver ion concentration directly measured from the periprosthetic tissue and the inluence on the clinical outcome. Material and Methods. Silver ions were evaluated in 5 mL wound luids two days postoperatively and in blood patients 7 and 14 days ater surgery using inductively coupled plasma emission spectrometry in 18 patients who underwent total joint replacement with a silver-coated megaendoprosthesis. Results. he concentration of silver ions averaged 0.08 parts per million. Patients who showed an increased silver concentration in the blood postoperatively presented a lower silver concentration in the wound luids and a delayed decrease in C-reactive protein levels. here were signiicantly fewer reinfections and shorter hospitalization in comparison with a group that did not receive a silver- coated megaprosthesis. Conclusion. An increased concentration of silver in the immediate surroundings of silver-coated prostheses was demonstrated for the irst time in cohorts of patients with trauma or tumors. An elevated concentration of silver ions in the direct periprosthetic tissue may have reduced the infection rate. 1. Introduction Applying megaprostheses to reconstruct osseous defects ater trauma, tumor, or infection has been well established for decades. hese implants can replace critical size osseous defects in long bones, such as in total joint revisions or ater local tumor resections [1–3]. One therapeutic challenge is the high infection rate in the latter group, which is approximately 35% in these patients compared to 1-2% in healthy individuals. herefore, some authors advocate using silver-coated prostheses in this special cohort [4]. Silver ions have a bactericide efect because they can attach to the DNA and thus inhibit protein synthesis [4, 5]. Moreover, it is evident that silver ions induce resistance to bacteria [6, 7]. Currently, silver-coated prostheses are applied mainly due to the following two indications: (1) for infection prophylaxis in tumor endoprosthetics and (2) as the last option for patients ater extensive trauma-related infection. In vitro studies have demonstrated the eiciency of silver ions compared to other metals in killing Staphylococcus epidermidis [8]. In rabbits, Gosheger et al. showed reduced infection rates ater the implantation of silver-coated pros- theses [9]. In a recent clinical trial, Hardes et al. presented a reduction of the infection rate to 5.9% in tumor patients compared to 17.6% in a control group [10]. However, there is still a lack in clinical data, and the current literature almost exclusively includes patient cohorts ater tumor surgery. Adequate large studies for total joint revision surgeries with silver-coated endoprostheses do not yet exist. At this time, the typical toxic side efects of silver, such as dermal argyria (i.e., blue or bluish-grey colored skin), ocular argyrosis, gastroenteritis or fever, have not been associated