Implant materials impregnated with antibiotics have long been used to manage the dead space created by debridement surgery in patients with osteomyelitis. To present our preliminary results and in vivo response of patients to PerOssal used to treat bone infection in the form of long bone chronic osteomyelitis. PerOssal is a new osteoconductive bone substitution material for bone filling which consists of an entirely synthetically produced, nanocrystalline hydroxyapatite and calcium sulfate. It can be used effectively as a local antibiotic carrier for the reconstruction of infected bone defects. We have treated 19 patients with long bone osteomyelitis (15 tibial, 4 femoral) with PerOssal impregnated with the appropriate antibiotic which was used following radical debridement surgery. In all cases we did not rely solely on the mechanical stability that it may provide but we supported the bone when necessary. Postoperative observations were focused on primary wound healing and clinical eradication of infection. We had: 15 eradication of infection, 2 recurrences, in terms of re-infection by different species or amputation, and 2 on-going cases. Declining wound leakage and delayed wound healing was present in 5 cases where PerOssal was used either intramedullarily but not sealed or extraosseously in relatively large amounts. We have so far good results with respect to infection control. PerOssal seems to perform better when used in contained defects whereas extraosseous use seems to predispose to prolonged leakage and compromised wound healing or breakdown. The mechanical stability that it provides remains under consideration.
Two-stage revision procedure is the gold standard in management of periprosthetic infections. Cement spacers have long been used to preserve the space created during resection procedure and to release antiobiotics within the created dead space. However, the problems related to cement as an antibiotic carrier are well recognised (thermal necrosis, random porosity, unspecified antibiotic delivery rate). To present the concept of using PerOssal as a canal filling spacer and local antibiotic delivery system in two-stage revisions of hip and knee infected arthroplasty. 8 patients (6 females, 2 males) with infected arthroplasty (4 TKRs, 4 THRs) were managed with two-stage revision procedures during the years 2006–2008 (minimum FU: 12 months). Our protocol consisted of:
Preoperative determination of the causative organism Radical debridement surgery and cement spacer with PerOssal implantation Appropriate IV antibiotic therapy for 6 weeks, postoperative clinical evaluation and monitoring of inflammation markers After a six-week antibiotic free interval and inflammation markers normalization second stage surgery took place: Medullary canal reaming, intraoperative cultures, thorough wound irrigation and prostheses implantation Postoperative antibiotic therapy until culture results; IV antibiotic treatment for 6 more weeks if they were positive. FU evaluation at 3, 6, 12, and 24 months. We had 7 cases with eradication of infection, 2 with delayed wound closure, and 1 late recurrence of disease. We think that PerOssal can offer a very useful additional and genuine support in managing infected joint arthroplasties with so far good clinical results.
Preoperative determination of the causative organism its sensitivity to antibiotics Radical debridement surgery and cement spacer with PerOssal implantation Appropriate IV antibiotic therapy for 6 weeks and postoperative clinical evaluation and monitoring of inflammation markers After a six-week antibiotic free interval and if inflammation markers had return to normal second stage surgery took place: Medullary canal reaming, intraoperative cultures, thorough wound irrigation with 10L NS and prosthesis implantation Postoperative antibiotic therapy until culture results; IV antibiotic treatment for 6 more weeks if they were positive. FU evaluation at 3, 6, 12, and 24 months.
