Abstract
Introduction and Aims: The delivery of local antibiotics from a biodegradable implant for orthopedic infections is an attractive alternative. The implant delivers high tissue levels of antibiotic, obliterates dead space, aides in bone repair and does not require removal. This is a review of our clinical experience with custom-made calcium sulfate antibiotic implants (Osteoset BVF®, Wright Medical Technology, Arlington, TN).
Method: Between 12/1996 and 1/2003, 156 procedures using biodegradable beads for orthopaedic infections were performed. Two patients were lost to follow-up. One elderly patient died from post-operative respiratory failure. One patient was lost to follow-up. There were 154 procedures in the analysis group performed on 145 patients (55 female: 90 male). The average age of the population was 45 years (1–85 years). The inclusion in the study required that a patient have an orthopedic infection (osteomyelitis/septic arthritis), which was either biopsy- or culture-proven. The population included 36 patients with a failed arthroplasty, 41 infected nonunions, 50 patients with chronic osteomyelitis, and 27 patients with acute or post-operative bone infections. Patients were treated initially with surgical debridement and insertion of calcium sulfate beads with either Tobramycin and/or Vancomycin. All patients received oral antibiotics or intravenous antibiotics.
Results: Length of follow-up averaged 17 months (six to 67 months). Of the 154 patients, 142 became free of infection (92%). Five patients required multiple surgical procedures involving beads and further debridement to obtain an infection-free status. Many of these patients had an initial attempt at retaining a metal arthroplasty in an initial septic situation. In those patients, infection control required removal of the foreign material. Complete implant degradation occurred in all cases. Five patients had an episode post-operatively of early wound drainage, which was treated with sterile dressing changes while on intravenous antibiotics. In all patients the drainage ceased and the patients did not require further surgery.
Conclusion: Biodegradable calcium sulfate antibiotic implants, along with adjunctive antibiotics, controlled a variety of infections, obliterated dead space and aided in bone repair. Subsequent bone grafting was not required for intramedullary defects due to the osteoconductive properties of calcium sulfate. Biodegradable antibiotic beads appear effective in controlling localised orthopedic infections and do not require a second procedure for removal.
These abstracts were prepared by Editorial Secretary, George Sikorski. Correspondence should be addressed to Australian Orthopaedic Association, Ground Floor, The William Bland Centre, 229 Macquarie Street, Sydney, NSW 2000, Australia.
At least one of the authors is receiving or has received material benefits or support from a commercial source.
