title: A comparative study of the use of bioactive glass S53P4 and antibiotic-loaded calcium-based bone substitutes in the treatment of chronic osteomyelitis: a retrospective comparative study.
abstract: 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.
authors.affiliation: IRCCS Galeazzi Orthopaedic Institute, Department of Reconstructive Surgery of Osteo-articular Infections, Via R Galeazzi, Milan, Italy.
authors.forename: C L
authors.initials: CL
authors.lastname: Romanò
authors.affiliation: IRCCS Galeazzi Orthopaedic Institute, Department of Reconstructive Surgery of Osteo-articular Infections, Via R Galeazzi, Milan, Italy.
authors.forename: N
authors.initials: N
authors.lastname: Logoluso
authors.affiliation: G Pini Orthopaedic Institute, Department of Osteo articular Infections, Piazza Cardinal Ferrari, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: Meani
authors.affiliation: IRCCS Galeazzi Orthopaedic Institute, Department of Reconstructive Surgery of Osteo-articular Infections, Via R Galeazzi, Milan, Italy.
authors.forename: D
authors.initials: D
authors.lastname: Romanò
authors.affiliation: IRCCS Galeazzi Orthopaedic Institute, Laboratory of Clinical Chemistry and Microbiology, Via R Galeazzi, Milan, Italy.
authors.forename: E
authors.initials: E
authors.lastname: De Vecchi
authors.affiliation: IRCCS Galeazzi Orthopaedic Institute, Laboratory of Clinical Chemistry and Microbiology, Via R Galeazzi, Milan, Italy.
authors.forename: C
authors.initials: C
authors.lastname: Vassena
authors.affiliation: IRCCS Galeazzi Orthopaedic Institute, Laboratory of Clinical Chemistry and Microbiology, Via R Galeazzi, Milan, Italy.
authors.forename: L
authors.initials: L
authors.lastname: Drago
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D018786:Bone Substitutes / Q000627:therapeutic use*; D002133:Calcium Sulfate / Q000494:pharmacology; D002908:Chronic Disease; D015331:Cohort Studies; D003131:Combined Modality Therapy; D003646:Debridement / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D005898:Glass; D006801:Humans; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged; D010019:Osteomyelitis / Q000175:diagnosis* / Q000628:therapy*; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D018709:Statistics, Nonparametric; D013997:Time Factors; D014057:Tomography, X-Ray Computed / Q000379:methods; D016896:Treatment Outcome; D014945:Wound Healing / Q000502:physiology; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D018786:Bone Substitutes; C403922:bioactive glass S53P4; D002133:Calcium Sulfate
keywords: Bioglass; Bone; Bone substitute; Infection; Osteomyelitis