title: Single-stage treatment of chronic osteomyelitis with a new absorbable, gentamicin-loaded, calcium sulphate/hydroxyapatite biocomposite: a prospective series of 100 cases.
abstract: OBJECTIVE
  Chronic osteomyelitis may recur if dead space management, after excision of infected bone, is inadequate. This study describes the results of a strategy for the management of deep bone infection and evaluates a new antibiotic-loaded biocomposite in the eradication of infection from bone defects.
  
  
  METHODS
  We report a prospective study of 100 patients with chronic osteomyelitis, in 105 bones. Osteomyelitis followed injury or surgery in 81 patients. Nine had concomitant septic arthritis. 80 patients had comorbidities (Cierny-Mader (C-M) Class B hosts). Ten had infected nonunions. All patients were treated by a multidisciplinary team with a single-stage protocol including debridement, multiple sampling, culture-specific systemic antibiotics, stabilisation, dead space filling with the biocomposite and primary skin closure.
  
  
  RESULTS
  Patients were followed up for a mean of 19.5 months (12 to 34). Infection was eradicated in 96 patients with a single procedure and all four recurrences were successfully managed with repeat surgery. Adverse events were uncommon, with three fractures, six wound leaks and three unrelated deaths. Outcome was not dependant on C-M host class, microbial culture, wound leakage or presence of nonunion.
  
  
  CONCLUSIONS
  This single-stage protocol, facilitated by the absorbable local antibiotic, is effective in the treatment of chronic osteomyelitis. It offers a more patient-friendly treatment compared with other published treatment options. Cite this article: Bone Joint J 2016;98-B:1289-96.
authors: Nuffield Orthopaedic Centre, The Bone Infection Unit, Oxford University Hospitals Foundation NHS Trust, Oxford OX3 7HE, UK.
authors: M A
authors: MA
authors: McNally
authors: Nuffield Orthopaedic Centre, The Bone Infection Unit, Oxford University Hospitals Foundation NHS Trust, Oxford OX3 7HE, UK.
authors: J Y
authors: JY
authors: Ferguson
authors: Nuffield Orthopaedic Centre, The Bone Infection Unit, Oxford University Hospitals Foundation NHS Trust, Oxford OX3 7HE, UK.
authors: A C K
authors: AC
authors: Lau
authors: Nuffield Orthopaedic Centre, The Bone Infection Unit, Oxford University Hospitals Foundation NHS Trust, Oxford OX3 7HE, UK.
authors: M
authors: M
authors: Diefenbeck
authors: Nuffield Orthopaedic Centre, The Bone Infection Unit, Oxford University Hospitals Foundation NHS Trust, Oxford OX3 7HE, UK.
authors: M
authors: M
authors: Scarborough
authors: Nuffield Orthopaedic Centre, The Bone Infection Unit, Oxford University Hospitals Foundation NHS Trust, Oxford OX3 7HE, UK.
authors: A J
authors: AJ
authors: Ramsden
authors: Nuffield Orthopaedic Centre, The Bone Infection Unit, Oxford University Hospitals Foundation NHS Trust, Oxford OX3 7HE, UK.
authors: B L
authors: BL
authors: Atkins
mesh_terms: D001672:Biocompatible Materials; D001861:Bone Regeneration / Q000187:drug effects; D018786:Bone Substitutes; D002133:Calcium Sulfate / Q000627:therapeutic use*; D002908:Chronic Disease; D015331:Cohort Studies; D003646:Debridement / Q000379:methods; D004343:Drug Implants; D017886:Durapatite / Q000627:therapeutic use*; D005260:Female; D005500:Follow-Up Studies; D005839:Gentamicins / Q000627:therapeutic use*; D006801:Humans; D008297:Male; D010019:Osteomyelitis / Q000175:diagnosis / Q000188:drug therapy*; D011446:Prospective Studies; D011859:Radiography / Q000379:methods; D018570:Risk Assessment; D016896:Treatment Outcome; D014945:Wound Healing / Q000187:drug effects / Q000502:physiology*
chemical_list: D001672:Biocompatible Materials; D018786:Bone Substitutes; D004343:Drug Implants; D005839:Gentamicins; D017886:Durapatite; D002133:Calcium Sulfate
keywords: Absorbable biocomposite; Calcium sulphate; Hydroxyapatite; Infected nonunion; Osteomyelitis; Outcome