The treatment of chronic osteomyelitis often
includes surgical debridement and filling the resultant void with antibiotic-loaded
polymethylmethacrylate cement, bone grafts or bone substitutes.
Recently, the use of bioactive glass to treat bone defects in infections
has been reported in a limited series of patients. However, no direct comparison
between this biomaterial and antibiotic-loaded bone substitute has
been performed. In this retrospective study, we compared the safety and efficacy
of surgical debridement and local application of the bioactive glass
S53P4 in a series of 27 patients affected by chronic osteomyelitis
of the long bones (Group A) with two other series, treated respectively
with an antibiotic-loaded hydroxyapatite and calcium sulphate compound
(Group B; n = 27) or a mixture of tricalcium phosphate and an antibiotic-loaded
demineralised bone matrix (Group C; n = 22). Systemic antibiotics
were also used in all groups. After comparable periods of follow-up, the control of infection
was similar in the three groups. In particular, 25 out of 27 (92.6%)
patients of Group A, 24 out of 27 (88.9%) in Group B and 19 out
of 22 (86.3%) in Group C showed no infection recurrence at means
of 21.8 (12 to 36), 22.1 (12 to 36) and 21.5 (12 to 36) months follow-up,
respectively, while Group A showed a reduced wound complication
rate. Our results show that patients treated with a bioactive glass
without local antibiotics achieved similar eradication of infection
and less drainage than those treated with two different antibiotic-loaded
calcium-based bone substitutes. Cite this article:
The aim of our study was to investigate whether placing of the femoral component of a hip resurfacing in valgus protected against spontaneous fracture of the femoral neck. We performed a hip resurfacing in 20 pairs of embalmed femora. The femoral component was implanted at the natural neck-shaft angle in the left femur and with a 10° valgus angle on the right. The bone mineral density of each femur was measured and CT was performed. Each femur was evaluated in a materials testing machine using increasing cyclical loads. In specimens with good bone quality, the 10° valgus placement of the femoral component had a protective effect against fractures of the femoral neck. An adverse effect was detected in osteoporotic specimens. When resurfacing the hip a valgus position of the femoral component should be achieved in order to prevent fracture of the femoral neck. Patient selection remains absolutely imperative. In borderline cases, measurement of bone mineral density may be indicated.
