The effect of calcium sulfate/calcium phosphate composite for the treatment of chronic osteomyelitis compared with calcium sulfate.

Abstract

Treatment of chronic osteomyelitis often requires surgical debridement in combination with bone defect reconstruction and antibiotics administration. We aimed at investigating and evaluating the effect of antibiotic-loaded absorbable calcium sulfate/calcium phosphate (CS/CP) composite as bone substitute in the treatment of chronic osteomyelitis compared with CS. A retrospective study of 31 consecutive patients with chronic osteomyelitis from one medical center was conducted. The treatment involved thorough debridement, antibiotic loaded bone substitutes filling (group A: CS/CP, 21 patients, group B: CS, 10 patients), laboratory and radiographic examination, and culture-specific systemic antibiotic treatment guided by a multidisciplinary team. New bone formation property and resorption kinetics were analyzed through X-ray and CT scan qualitatively and quantitatively. Anti-infection effect was mainly analyzed by postoperative laboratory examination and healing of wound. The average follow-up in each group was 61.3 and 86.7 weeks, respectively. In group A (CS/ CP), no patient had recurrent infection at 17 months after surgery, 1 case had delayed wound healing and healed after dressing change. In group B (CS), 2 patients had recurrent infection at 18 weeks after surgery, and were managed after further surgical treatment, 3 cases had delayed wound healing and healed after dressing change. The infection in the two groups was mainly caused by staphylococcus aureus. The average percentage of new bone formation was 20.5%, 43.7%, 75.2% at 1, 3, and 6 months in group A and 15.4%, 32.2%, 49.7% at 1, 3, and 6 months in group B after operation (P=0.001 at 1 month, P=0.025 at 3 months, P=0.000 at 6 months). The average percentage of resorption was 23.7%, 56.4%, 81.2% at 1, 3, and 6 months in group A and 47.1%, 96.2%, 100% at 1, 3, and 6 months in group B after operation (P=0.000 at 1 month, P=0.000 at 3 months, P=0.000 at 6 months). There was difference in infection recurrence (P=0.034). Our preliminary results proved that compared with CS, this novel antibiotic-impregnated CS/CP composite acted as superior scaffold for bone formation with a lower rate of infection recurrence, when choosing bone substitutes in the treatment of chronic osteomyelitis.