The Joint EBJIS-MSIS 2026 Conference

Background:

Periprosthetic infection remains a significant source of morbidity in endoprosthesis reconstruction

Quaternary ammonium coating technology [NanoCept; Onkos Surgical, Parsippany, NJ] was FDA approved on 12/19/2024

Purpose: compare early clinical outcomes between quaternary ammonium-coated (QAC) and uncoated lower extremity endoprostheses

Hypothesis: QAC implants would demonstrate lower rates of infection and revision

Methods:

A retrospective cohort study was performed between December 2022 and October 2025

Reconstructions included:

-Total Femur Replacement (TFR)

-Proximal Femur Replacement (PFR)

-Distal Femur Replacement (DFR)

-Proximal Tibia Replacement (PTR)

Stratified based on the use of QAC vs uncoated implants

Primary outcomes included periprosthetic infection and repeat surgery

Secondary outcomes included wound complications and implant survivorship

For QAC implants, the percentage of the implant’s surface area was coated was calculated

Results:

Reconstructions:

Average length of reconstruction: 197mm (Range: 111-505mm)

Average length of NanoCept coating: 82.8mm (Range: 40-260mm)

Percentage length of NanoCept coating: 39% (Range: 22-77%)

Percentage surface area of NanoCept coating: 17% (Range: 7-38%)

Highlighted cases of QAC reconstruction with long-term infection:

Green Circle: Chronic Suppressive Antibiotics

61F underwent TFR for chronically infected THA and DFR

Blue Circle: Chronic Suppressive Antibiotics

64F underwent TFR for chronically infected DFR with bone loss

Red Circle: Above Knee Amputation

65M underwent revision DFR for chronically infected DFR and failed soft tissue coverage

Discusssion:

For primary oncology indications, there were no infections with QAC use

Decreased utilization of chronic suppressive antibiotics

Class B hosts and Class C tissue make aseptic revisions still diffiicult

Limitations: early results, limited sample size

Comparing Early Outcomes of Antibacterial-coated vs Uncoated Endoprostheses: A Single Institutions Experience with Quaternary Ammonium Technology