title: The use of a biodegradable antibiotic-loaded calcium sulphate carrier containing tobramycin for the treatment of chronic osteomyelitis: a series of 195 cases.
abstract: We report our experience using a biodegradable calcium sulphate antibiotic carrier containing tobramycin in the surgical management of patients with chronic osteomyelitis. The patients were reviewed to determine the rate of recurrent infection, the filling of bony defects, and any problems with wound healing. A total of 193 patients (195 cases) with a mean age of 46.1 years (16.1 to 82.0) underwent surgery. According to the Cierny-Mader classification of osteomyelitis there were 12 type I, 1 type II, 144 type III and 38 type IV cases. The mean follow-up was 3.7 years (1.3 to 7.1) with recurrent infection occurring in 18 cases (9.2%) at a mean of 10.3 months post-operatively (1 to 25.0). After further treatment the infection resolved in 191 cases (97.9%). Prolonged wound ooze (longer than two weeks post-operatively) occurred in 30 cases (15.4%) in which there were no recurrent infection. Radiographic assessment at final follow-up showed no filling of the defect with bone in 67 (36.6%), partial filling in 108 (59.0%) and complete filling in eight (4.4%). A fracture occurred in nine (4.6%) of the treated osteomyelitic segments at a mean of 1.9 years (0.4 to 4.9) after operation. We conclude that Osteoset T is helpful in the management of patients with chronic osteomyelitis, but the filling of the defect in bone is variable. Prolonged wound ooze is usually self-limiting and not associated with recurrent infection.
authors.affiliation: Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Windmill Road, Headington, Oxford, OX3 7LD, UK.
authors.forename: J Y
authors.initials: JY
authors.lastname: Ferguson
authors.affiliation: The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Windmill Road, Headington, Oxford, OX3 7LD, UK.
authors.forename: M
authors.initials: M
authors.lastname: Dudareva
authors.affiliation: Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Windmill Road, Headington, Oxford, OX3 7LD, UK.
authors.forename: N D
authors.initials: ND
authors.lastname: Riley
authors.affiliation: Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Windmill Road, Headington, Oxford, OX3 7LD, UK.
authors.forename: D
authors.initials: D
authors.lastname: Stubbs
authors.affiliation: The Bone Infection Unit, Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Windmill Road, Headington, Oxford, OX3 7LD, UK.
authors.forename: B L
authors.initials: BL
authors.lastname: Atkins
authors.affiliation: Nuffield Orthopaedic Centre, Oxford University Hospitals NHS Trust, Windmill Road, Headington, Oxford, OX3 7LD, UK.
authors.forename: M A
authors.initials: MA
authors.lastname: McNally
mesh_terms: D020341:Absorbable Implants; D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019072:Antibiotic Prophylaxis / Q000379:methods*; D002133:Calcium Sulfate / Q000494:pharmacology*; D002908:Chronic Disease; D015331:Cohort Studies; D003646:Debridement / Q000379:methods; D004337:Drug Carriers; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007430:Intraoperative Care / Q000379:methods; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis / Q000188:drug therapy* / Q000601:surgery; D011446:Prospective Studies; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D014031:Tobramycin / Q000008:administration & dosage*; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects / Q000502:physiology
chemical_list: D004337:Drug Carriers; D014031:Tobramycin; D002133:Calcium Sulfate
keywords: Bone infection; Osteomyelitis; Antibiotic carrier; Calcium sulphate; Biodegradable