Abstract
Osteomyelitis is an infectious process in bone occasionally leading to bone destruction. Traditionally a two-stage operation is performed using PMMA + antibiotic beads or a spacer. In the second operation the void filler is removed and the defect is filled with autologous bone.
Bioactive glass (BAG) S53P4 is an antibacterial biodegradable bone substitute. This feature is based on an increase in pH and the osmotic pressure around the BAG, a phenomenon which has been shown to kill both planktonic bacteria and bacteria in biofilm in-vitro.
We analyzed retrospectively our early results of osteomyelitis patients treated with BAG from the patient's clinical history
The diagnosis was stated in addition to bacterial samples by MRI, CT and plain radiographs or by a combination of these. Between 2007–2013 we applied BAG as a void-filler in 20 cases (15 male and 5 female) of osteomyelitis in the lower (19) or the upper (1) limb in one-stage procedure. The patients had been suffering from symptoms of osteomyelitis a mean 3,5 months (0,25–24,00) and had a history of mean 3,5 (1–11) earlier operations.
Osteomyelitis was estimated to be healed when the enclosed systemic antibiotic treatment and clinical controls were carried out and the patient didn't have symptoms of a persisting disease.
The average postoperative follow up was 7,8 (3,0–59,0) months. Fifteen (75%) of the patients healed. One patient run out of controls, but was symptom free during his last visit. In four cases we had to remove the bioactive glass because of continuous secretion. In three cases the debridement was incomplete and one had a poor soft tissue cover and a candida infection. Adjuvant systemic antibiotic treatment was prescribed postoperatively 7,3 (4–19) weeks.
Bioactive glass is an effective void filling material in the treatment of osteomyelitis. Proper debridement and a soft tissue cover should be performed.
Main reason for that the five patients did not heal is, that this procedure is new and we were looking for the right indications and techniques.
