Aim. Antibiotic-eluting calcium compounds can be used to deliver antibiotics in the management of prosthetic joint infection (PJI). Described omplications include wound drainage, heterotopic ossification(HO) as well as hypercalcaemia which is potentially life threatening. The aim of this study is to assess the incidence of hypercalcaemia and other complications between two calcium based antibiotic delivery systems. Method. A retrospective study was performed. Thirty two patients treated with Stimulan or Cerament Calcium based antibiotic delivery system between August 2014 to January 2017 were included. Seven patients received Cerament, 21 cases received Stimulan and one patient received both. The volume used as well as pre- and post-operative serum calcium were recorded as well as any wound related complications and radiologic changes suggestive of heterotopic ossification. The postoperative serum adjusted Calcium were taken weekly during the initial post operative period. Patients with overactive parathyroid disease and pre-existing renal disease were excluded. Results. Stimulan group (n=22, Mean volume 39.2ml). Mean pre-operative serum calcium was 2.48mmol/l. At 1 and 2 weeks post-surgery mean levels were 2.51 and 2.47mmol/l (patients receiving <40ml), and 2.47 and 2.50mmol/l (patients receiving >40ml – 9 cases) respectively. There was no significant difference between pre/post-operative levels at 1 (p=0.97) or 2 weeks (p=0.91) and no difference between those treated with <40ml or >40ml of Stimulan at 1 or 2 weeks (p=0.91). Cerament group (n=8, Mean volume 9.4ml). Mean pre-operative serum calcium was 2.42mmol/l. Mean post-operative levels at 1 and 2 weeks post-surgery were 2.44mmol/l (p=0.92) and 2.37mmol/l (p=0.61) respectively. One patient had prolonged wound discharge and required re operation. No HO was encountered. Conclusions. Our results suggest that hypercalcaemia and other complications are uncommon with the use calcium based antibiotic delivery systems and that calcium based antibiotic delivery systems are safe in the treatment of PJI

A multimodality approach is needed for management of infected joint replacement prostheses and infected skeletal metalwork. We present our results in six patients managed surgically with standard techniques, with the addition of a local antibiotic delivery system using absorbable Calcium Sulphate beads. A retrospective study was undertaken of 6 patients with established musculoskeletal infection in relation to existing metalwork. Two patients had infection in the hip replacement prosthesis, three had infected prosthetic knee joints and one had infection in a femoral locking plate. All were treated with extensive debridement, revision / retention of implants, parenteral antibiotics and local antibiotics. Patients were followed up in clinic for resolution of inflammatory markers and subsidence of signs of infection. Control of infection was achieved in five patients at average 19 months followup. One patient had persistent infection and has undergone further surgery. In this preliminary study, we found local antibiotic delivery using absorbable calcium sulphate beads to be an effective adjuvant to standard debridement, parenteral antibiotics and revision of implants

Evaluation of the surgical approach and treatment outcomes in patients with chronic osteomyelitis of the tibia classified as anatomic type 3 and 4, physiologic class B (Cierny-Mader). Analysis of surgical treatment of 68 patients (average age of 45.6 years) with chronic osteomyelitis of the tibia covered the period from June 1, 2013 till January 1, 2015. There were 49 males (72%). The first (I) group included 39 patients with type 3 chronic osteomyelitis of the tibia, the second (II) group – 29 patients with type 4 osteomyelitis. The follow-up was for 1–18 months. Duration of the surgery, intraoperative blood loss, causes of osteomyelitis and the frequency of infection recurrence were evaluated. In the group I, 33.3% of patients underwent debridement of the infected site and replacement of the bone defect with an antibiotic-laden cement spacer. In 28.2% of cases, a biodegradable antibiotic delivery system was used for the replacement. 23.1% of cases involved muscle flap coverage of the bone and tissue defect, while 15.4% – treatment with external fixation. In the group II, the proportion of cases treated with external fixation was 58.6%. It was higher than in group I (p<0.01). 27.6% of patients in this group had their defects replaced with an antibiotic-laden cement spacer, whereas 10.3% had muscle flap coverage. One patient had amputation of the tibia. Duration of the surgery and blood loss in group II was 2.4 and 1.7 times higher than in group I. The frequency of infection recurrence in both groups was comparable (about 13%). The average time of its manifestation was 20.8 days in group II and 41.6 days in group I. Infection recurrence after muscle flap coverage was not observed. S.aureus was the most common pathogen in both groups (50–60%). Microbial associations were isolated in 28.3 and 38% of cases in groups I and II, respectively. 33.3% of patients experienced infection caused by P.аeruginosa. Differences in the blood loss and duration of the surgery were due to the larger volume of the affected tissues in type 4 chronic osteomyelitis of the tibia. High frequency of infection recurrence was observed in patients with microbial associations and P.aeruginosa. The surgical treatment of choice for these patients might be muscle flap coverage. It is necessary to consider the type of a pathogen for systemic and local antimicrobial therapy

We describe our medium-term results for the management of chronic osteomyelitis in long bones using the Lautenbach procedure. Seventeen consecutive patients (18 segments) were treated prospectively. Osteomyelitis had been present for a mean of 12.5 years (1 to 31). A discharging sinus was present in all cases. Nine of the associated fractures had failed to unite and a further two needed correction of malunion. The Lautenbach procedure involves debridement, intramedullary reaming and the insertion of double-lumen tubes to establish both a local antibiotic delivery system and cavity analysis for volume and culture. The end-point of treatment is when the irrigate produces three consecutive clear cultures with improvement in the blood indices and obliteration of the cavity volume. The mean length of treatment was 27 days (14 to 48). One patient required a second procedure and another local debridement for recurrence of the infection. Two patients had Papineau grafting because of cortical defects. All the patients have subsequently remained free from infection. After treatment 11 had internal or external fixation for treatment of non- or malunion or a joint replacement, including two successful limb-lengthening procedures. Two further patients, while cured of infection, underwent amputation for other reasons. The mean length of follow-up was 75 months. This procedure allows precise control over the osteomyelitis until objective assessment suggests that infection has been cleared and the cavity obliterated. We recommend this procedure for long-standing complex cases in which basic techniques using debridement and antibiotics have failed

Aims

The standard of wide tumour-like resection for chronic osteomyelitis (COM) has been challenged recently by adequate debridement. This paper reviews the evolution of surgical debridement for long bone COM, and presents the outcome of adequate debridement in a tertiary bone infection unit.