Introduction

The treatment of chronic osteomyelitis involves a debridement of affected non-viable tissue and the use of antibiotics. Where surgery leaves a cavity, dead space management is practised with antibiotic impregnated cement. These depots of local antibiotics are variable in elution properties and need removal. We review the use of bioabsorbable synthetic calcium sulphate as a carrier of gentamicin and as an adjunct in treating intramedullary osteomyelitis.

The treatment of chronic osteomyelitis involves a debridement of affected non-viable tissue and the use of antibiotics. Where surgery leaves a cavity, dead space management is practised with antibiotic impregnated cement. These depots of local antibiotics are variable in elution properties and need removal. We review the use of bioabsorbable synthetic calcium sulphate as a carrier of gentamicin and as an adjunct in treating intramedullary osteomyelitis.

A retrospective review of cases treated consecutively from 2006 to 2010 in the Royal Liverpool University Hospital was undertaken. Variables recorded included aetiology, previous interventions, diagnostic criteria, radiological features, serology and microbiology. The Cierney-Mader system was used to classify. Treatment involved removal of implants (if any), intramedullary debridement and local resection (if needed), lavage and instillation of the gentamicin carrier, supplemented with systemic antibiotics. Follow-up involved a survival analysis to time to recurrence, clinical and functional assessment (AOFAS-Ankle/IOWA knee/Oxford Hip) and general health outcome (SF36).

There were 31 patients (22 male, 9 female). The mean age was 47 years (20-67). Twenty-five cases were post-surgery (6 open fractures) and 6 were haematogenous in origin. The median duration of osteomyelitis was 1.6yrs. The bones affected were 42% femur, 45% tibia, 3% radius and 10% humerus. 11 cases had diffuse as well as intramedullary involvement. 9 cases underwent segment resection and bone transport. We identified Staphylococcus Aureus in 16 and Coagulase Negative Staphylococcus in 6 cases. The median follow-up was 1.7 years (0.5-5.6). The median scores attained were: AOFAS-78, DASH-32, IOWA-71, Oxford-32. There were two recurrences.

Dead space management of intramedullary infections is difficult. We describe a method for delivery of local antibiotics and provide early evidence to its efficacy. The treatment success to date is 93%.

Bioabsorbable carriers of antibiotics are efficacious adjuncts to surgical treatment of intramedullary osteomyelitis.

We report our experience with LCS Patellofemoral joint replacement. Between September 2003 and November 2007, 66 consecutive patients were reviewed retrospectively who underwent LCS patellofemoral joint replacement. There were 13 males and 51 females with a mean age of 61.6 years (range 43–78). The average follow-up was 22 months (range 11–51 months). To assess the outcome, revision for any cause was taken as the end point for this study.

A total of 14 (21.2%) revision operations were carried out at an average of 15.6 months (range 8–29 months) from the initial operation. The reasons for revision were mal-tracking of patella (3), dislocated patellar button (2), persistent unexplained pain (5) and progression of arthritis (4). Amongst the remaining 52 patients, 8 are still experiencing pain and not entirely satisfied with the procedure. 42 patients (63%) have a satisfactory outcome so far. All of them who underwent revision to a total knee replacement were satisfied with their outcome with relief in their symptoms. Revision to a total knee replacement is not a straightforward procedure, especially removing the metal backed patellar component.

The revision rate of over 21% is unacceptably high to recommend the procedure as a routine. Based on our experience, we conclude that LCS patellofemoral replacement should be used with caution.