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VOLUME 15 , ISSUE 2 ( May-August, 2020 ) > List of Articles


Limb-saving Knee Arthrodesis with a Silver-coated Arthrodesis Rod in a Patient with Aspergillus Osteomyelitis of the Knee

Abdullah Ismat, Volker Alt, Christian Heiss, Markus Rupp

Citation Information : Ismat A, Alt V, Heiss C, Rupp M. Limb-saving Knee Arthrodesis with a Silver-coated Arthrodesis Rod in a Patient with Aspergillus Osteomyelitis of the Knee. 2020; 15 (2):121-125.

DOI: 10.5005/jp-journals-10080-1445

License: CC BY-NC-SA 4.0

Published Online: 04-03-2021

Copyright Statement:  Copyright © 2020; The Author(s).


Aspergillus osteomyelitis can be a very debilitating disease with an associated mortality of up to 25%. Silver is well known for its broad antimicrobial properties including activity against fungi and the coating of orthopaedic implants with silver has been reported to be successful in complex cases. We report for the first time on a complicated case of Aspergillus osteomyelitis affecting the left knee in a patient with a chronic lymphoid leukaemia treated with appropriate surgical debridement, local and systemic antibiotic and antimycotic therapy, as well as staged surgical treatment with final limb-saving arthrodesis by using a custom-made microsilver coated arthrodesis rod.

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  1. Heinekamp T, Schmidt H, Lapp K, et al., Interference of Aspergillus fumigatus with the immune response. Paper presented at: Seminars in immunopathology 2015.
  2. Fernstrom A, Goldblatt M. Aerobiology and its role in the transmission of infectious diseases. Journal of pathogens 2013;2013.
  3. Geiser DM. Sexual structures in Aspergillus: morphology, importance and genomics. Med Mycol 2009;47(Suppl 1):S21–S26. DOI: 10.1080/13693780802139859.
  4. Maschmeyer G, Haas A, Cornely OA. Invasive aspergillosis. Drugs 2007;67(11):1567–1601. DOI: 10.2165/00003495-200767110-00004.
  5. Gabrielli E, Fothergill AW, Brescini L, et al. Osteomyelitis caused by Aspergillus species: a review of 310 reported cases. Clin Microbiol Infect 2014;20(6):559–565. DOI: 10.1111/1469-0691.12389.
  6. Bariteau JT, Waryasz GR, McDonnell M, et al. Fungal osteomyelitis and septic arthritis. J Am Acad Orthop Surg 2014;22(6):390–401. DOI: 10.5435/JAAOS-22-06-390.
  7. Gamaletsou MN, Rammaert B, Bueno MA, et al. Aspergillus osteomyelitis: epidemiology, clinical manifestations, management, and outcome. J Infect 2014;68(5):478–493. DOI: 10.1016/j.jinf.2013.12.008.
  8. Sheehy SH, Atkins BA, Bejon P, et al. The microbiology of chronic osteomyelitis: prevalence of resistance to common empirical anti-microbial regimens. J Infect 2010;60(5):338–343. DOI: 10.1016/j.jinf.2010.03.006.
  9. Giger A, Yusuf E, Manuel O, et al. Polymicrobial vertebral osteomyelitis after oesophageal biopsy: a case report. BMC Infect Dis 2016;16(1):141. DOI: 10.1186/s12879-016-1471-9.
  10. Patterson TF, Thompson GR, Denning DW, et al. Practice guidelines for the diagnosis and management of aspergillosis: 2016 update by the infectious diseases society of America. Clin Infect Dis 2016;63(4): e1–e60. DOI: 10.1093/cid/ciw326.
  11. Lew DP, Waldvogel FA. Osteomyelitis. Lancet 2004;364(9431):369–379. DOI: 10.1016/S0140-6736(04)16727-5.
  12. Koehler P, Tacke D, Cornely OA. Aspergillosis of bones and joints–a review from 2002 until today. Mycoses 2014;57(6):323–335. DOI: 10.1111/myc.12165.
  13. Haidar R, Der Boghossian A, Atiyeh B. Duration of post-surgical antibiotics in chronic osteomyelitis: empiric or evidence-based? Int J Infect Dis 2010;14(9):e752–e758. DOI: 10.1016/j.ijid.2010.01.005.
  14. Brady RA, Leid JG, Calhoun JH, et al. Osteomyelitis and the role of biofilms in chronic infection. Pathog Dis 2008;52(1):13–22. DOI: 10.1111/j.1574-695X.2007.00357.x.
  15. Sealy PI, Nguyen C, Tucci M, et al. Delivery of antifungal agents using bioactive and nonbioactive bone cements. Ann Pharmacother 2009;43(10):1606–1615. DOI: 10.1345/aph.1M143.
  16. Grimsrud C, Raven R, Fothergill A, et al. The in vitro elution characteristics of antifungal-loaded PMMA bone cement and calcium sulfate bone substitute. Orthopedics 2011;34(8):e378–e381. DOI: 10.3928/01477447-20110627-05.
  17. Rouse MS, Heijink A, Steckelberg JM, et al. Are anidulafungin or voriconazole released from polymethylmethacrylate in vitro? Clin Orthopaed Relat Res 2011;469(5):1466–1469. DOI: 10.1007/s11999-010-1643-7.
  18. Wafa H, Grimer RJ, Reddy K, et al. Retrospective evaluation of the incidence of early periprosthetic infection with silver-treated endoprostheses in high-risk patients. Bone Joint J 2015;97(2):252–257. DOI: 10.1302/0301-620X.97B2.34554.
  19. Hardes J, Von Eiff C, Streitbuerger A, et al. Reduction of periprosthetic infection with silver-coated megaprostheses in patients with bone sarcoma. J Surg Oncol 2010;101(5):389–395. DOI: 10.1002/jso.21498.
  20. Alt V, Bechert T, Steinrücke P, et al. An in vitro assessment of the antibacterial properties and cytotoxicity of nanoparticulate silver bone cement. Biomaterials 2004;25(18):4383–4391. DOI: 10.1016/j.biomaterials.2003.10.078.
  21. Panáček A, Kolář M, Večeřová R, et al. Antifungal activity of silver nanoparticles against Candida spp. Biomaterials 2009;30(31): 6333–6340. DOI: 10.1016/j.biomaterials.2009.07.065.
  22. Ogar A, Tylko G, Turnau K. Antifungal properties of silver nanoparticles against indoor mould growth. Sci Total Environm 2015;521:305–314. DOI: 10.1016/j.scitotenv.2015.03.101.
  23. Khalilpour P, Lampe K, Wagener M, et al. Ag/SiOxCy plasma polymer coating for antimicrobial protection of fracture fixation devices. J Biomed Mater Res Part B Appl Biomater 2010;94(1):196–202.
  24. Glehr M, Leithner A, Friesenbichler J, et al. Argyria following the use of silver-coated megaprostheses: no association between the development of local argyria and elevated silver levels. Bone Joint J 2013;95(7):988–992. DOI: 10.1302/0301-620X.95B7.31124.
  25. Zhang C, Chen M, Wang G, et al. Pd@ ag Nanosheets in combination with amphotericin B exert a Potent anti-Cryptococcal Fungicidal effect. PLoS ONE 2016;11(6):e0157000. DOI: 10.1371/journal.pone.0157000.
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