Abstract
Introduction: Chronic osteomyelitis is a challenging condition in the orthopedic practice and traditionally treated using local and systemic antibiotics in a two-stage surgical procedure. With the introduction of the antimicrobial biomaterial S53P4 bioactive glass (Bonalive®), chronic osteomyelitis can be treated in a one-stage procedure. This study evaluated the mid-term clinical results of patients treated with S53P4 bioactive glass for long bone chronic osteomyelitis. Methods: In this prospective multi-center study, patients from two different university medical centers in the Netherlands were included. One-stage treatment consisted of debridement surgery, implantation of S53P4 bioactive glass, and treatment with culture-based systemic antibiotics. If required, wound closure by a plastic surgeon was performed. The primary outcome was the eradication of infection, and a secondary statistical analysis was performed on probable risk factors for treatment failure. Results: In total, 78 patients with chronic cavitary long bone osteomyelitis were included. Follow-up was at least 12 months (mean 46; standard deviation, SD, 20), and 69 patients were treated in a one-stage procedure. Overall infection eradication was 85 %, and 1-year infection-free survival was 89 %. Primary closure versus local/muscular flap coverage is the only risk factor for treatment failure. Conclusion: With 85 % eradication of infection, S53P4 bioactive glass is an effective biomaterial in the treatment of chronic osteomyelitis in a one-stage procedure. A major risk factor for treatment failure is the necessity for local/free muscle flap coverage. These results confirm earlier published data, and together with the fundamentally different antimicrobial pathways without antibiotic resistance, S53P4 bioactive glass is a recommendable biomaterial for chronic osteomyelitis treatment and might be beneficial over other biomaterials.
Highlights
Chronic osteomyelitis is a challenging condition in the orthopedic practice and traditionally treated using local and systemic antibiotics in a two-stage surgical procedure
This study aims to further substantiate the clinical efficacy regarding treatment of long bone chronic osteomyelitis using S53P4 bioactive glass in a one-stage treatment
Patients with a confirmed chronic osteomyelitis of the long bones were included from two different university medical centers in the Netherlands, i.e., Maastricht University Medical Centre (MUMC+) and University Medical Centre Groningen (UMCG)
Summary
Chronic osteomyelitis is a challenging condition in the orthopedic practice and traditionally treated using local and systemic antibiotics in a two-stage surgical procedure. This study evaluated the mid-term clinical results of patients treated with S53P4 bioactive glass for long bone chronic osteomyelitis. A major risk factor for treatment failure is the necessity for local/free muscle flap coverage These results confirm earlier published data, and together with the fundamentally different antimicrobial pathways without antibiotic resistance, S53P4 bioactive glass is a recommendable biomaterial for chronic osteomyelitis treatment and might be beneficial over other biomaterials. Chronic osteomyelitis is a bacterial infection of the bone and bone marrow and is one of the biggest clinical challenges in current orthopedic practice It is predominantly posttraumatic and is often seen after orthopedic (open) fracture surgery but can be caused by a hematogenous spread or direct postoperative colonization (Lazzarini et al, 2004; Lew and Waldvogel, 2004). Van Vugt et al.: Mid-term clinical results of chronic cavitary long bone osteomyelitis treatment (up to 20 %–30 %) remain relatively high (Garcia Del Pozo et al, 2018; Tice et al, 2003)
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