Abstract
Bone loss, either due to a septic process or to surgical débridements, is frequently associated with bone infections. Bone loss may be present in septic non-unions, osteomyelitis or septic joint prosthesis. In each of these conditions the use of bone or bone substitutes may be indicated. However, the risk of septic recurrence makes the choice of the right implant in these patients particularly difficult.
Clinical cases are presented to show the different choices available. Attention is focussed on: (1) when, in the presence of bone loss, a bone graft can be avoided and with which suitable procedures good results can be obtained; (2) when and how autologous bone grafts should be used; (3) when homologous bone grafts or bone substitutes are indicated; (4) how bone grafts should be protected against bacterial adesion and proliferation; and (5) the role of new technologies, such as bone growth factors. In this regard the clinical results are presented of the use of platelet-rich plasma (PRP) added to autologous or homologous bone after bone débridement in six patients treated with two-stage non-cemented revision of septic hip prosthesis and in two patients with septic non-union of the femur. At a minimum follow-up of 6 months (max. 1 year), we did not observe any infection recurrence, while bone remodelling and clinical outcome were favourable.
The use of bone growth factors such as PRP possibly added to autologous or homologous bone appears to be a promising technique to achieve bone reconstruction in débrided bone infections. However, with the limited numbers of patients and the short-term follow-up conclusions cannot be drawn and the use of growth factors with this indication should be limited to selected cases: patients with wide bone loss and with no signs of active infections.
No international guidelines are available concerning bone reconstruction in infections. Clinical experience shows that different surgical procedures are effective and the choice should take into considerations the type and site of bone defect, the host type and the pathogenesis of the bone loss. Growth factors may be a useful tool in these conditions and further studies are indicated.
