Abstract
BackgroundChronic post-traumatic and postoperative osteomyelitis is a refractory disease which results in significant morbidity and mortality. The effect of combination therapy with vancomycin-loaded calcium sulfate and vancomycin-loaded polymethyl methacrylate (PMMA) was unknown.MethodsFifty-one patients suffering from chronic post-traumatic or postoperative osteomyelitis of the lower extremities were included in the retrospective investigation. The patients were assigned to the study group of the combination therapy with antibiotic-loaded calcium sulfate and antibiotic-loaded PMMA or the control group of the antibiotic-loaded PMMA. Hematological parameters, eradication of infection, rate of infection recurrence and reoperation rate were evaluated during the follow-up.ResultsThe cases were followed up for an average of 24 months (range, 15–48 months) after the first-stage surgical operation. In the study group, all the patients revealed complete calcium sulfate resorption at an average of 6 weeks (range, 30–60 days). In the study group, infection was primarily eradicated in 92.31% (24 of 26) of patients and re-operation rate of 7.69% (2 of 26) after the first-stage surgery. Two patients underwent further surgical operation in the study group. One case achieved infection eradication in the recurrent two cases, with a secondary infection eradication rate of 96.15% (25 of 26). There was no persistent infection in the study group. In the control group, infection was eradicated in 64.00% (16 of 25) of patients and re-operation rate was 36.00% (9 of 25) after the first-stage surgery. Nine patients in the control group underwent further surgical operation. Two case achieved infection eradication in these cases who suffered from persistent or recurrent infection, with a secondary infection eradication rate of 72.00% (18 of 25). There was more re-operation rate in the control group (PMMA group, 9 vs combination therapy group, 2; P = 0.034).ConclusionThe combination therapy with vancomycin-loaded calcium sulfate and vancomycin-loaded PMMA possibly achieved more effective control of infection in the treatment of osteomyelitis through synergistic effect. The immediate structural stabilization and higher concentration of antibiotic at the local site of infection may be achieved through the combination of biodegradable and non-biodegradable devices in the treatment of chronic post-traumatic and postoperative osteomyelitis.The study was retrospectively registered at 11/16/2016 (TRN: NCT02968693).
Highlights
Chronic post-traumatic and postoperative osteomyelitis is a refractory disease which results in significant morbidity and mortality
Proper treatment for chronic post-traumatic and postoperative osteomyelitis requires surgical debridement, elimination of dead space with local antibiotic delivery devices, which are obtained by implantation of antibiotic-loaded material, and systemic antibiotic therapy
Antibioticloaded polymethyl methacrylate (PMMA) has been the gold standard vehicle for local antibiotic delivery in the treatment of chronic osteomyelitis, because the antibiotic delivery system can offer the advantage of local release of high antibiotic level at the site of infection, and simultaneously enable the dead space originating from surgical debridement
Summary
Chronic post-traumatic and postoperative osteomyelitis is a refractory disease which results in significant morbidity and mortality. Proper treatment for chronic post-traumatic and postoperative osteomyelitis requires surgical debridement, elimination of dead space with local antibiotic delivery devices, which are obtained by implantation of antibiotic-loaded material, and systemic antibiotic therapy. Antibiotic-loaded bone cavity fillers which are consisted of degradable or non-degradable materials can be used for local antibiotic delivery devices This fills up the bone cavity after surgical debridement, and can reduce antibiotic concentration in serum and offer high concentration of antibiotic at the local site of infections [4,5,6,7,8]. Antibioticloaded PMMA has been the gold standard vehicle for local antibiotic delivery in the treatment of chronic osteomyelitis, because the antibiotic delivery system can offer the advantage of local release of high antibiotic level at the site of infection, and simultaneously enable the dead space originating from surgical debridement
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