title: Combination therapy with vancomycin-loaded calcium sulfate and vancomycin-loaded PMMA in the treatment of chronic osteomyelitis.
abstract: Chronic post-traumatic and postoperative osteomyelitis is a refractory disease which results in significant morbidity and mortality. The effect of combination therapy with vancomycin-loaded calcium sulfate and vancomycin-loaded polymethyl methacrylate (PMMA) was unknown.
  
  
  
  Fifty-one patients suffering from chronic post-traumatic or postoperative osteomyelitis of the lower extremities were included in the retrospective investigation. The patients were assigned to the study group of the combination therapy with antibiotic-loaded calcium sulfate and antibiotic-loaded PMMA or the control group of the antibiotic-loaded PMMA. Hematological parameters, eradication of infection, rate of infection recurrence and reoperation rate were evaluated during the follow-up.
  
  
  
  The cases were followed up for an average of 24 months (range, 15-48 months) after the first-stage surgical operation. In the study group, all the patients revealed complete calcium sulfate resorption at an average of 6 weeks (range, 30-60 days). In the study group, infection was primarily eradicated in 92.31% (24 of 26) of patients and re-operation rate of 7.69% (2 of 26) after the first-stage surgery. Two patients underwent further surgical operation in the study group. One case achieved infection eradication in the recurrent two cases, with a secondary infection eradication rate of 96.15% (25 of 26). There was no persistent infection in the study group. In the control group, infection was eradicated in 64.00% (16 of 25) of patients and re-operation rate was 36.00% (9 of 25) after the first-stage surgery. Nine patients in the control group underwent further surgical operation. Two case achieved infection eradication in these cases who suffered from persistent or recurrent infection, with a secondary infection eradication rate of 72.00% (18 of 25). There was more re-operation rate in the control group (PMMA group, 9 vs combination therapy group, 2; P = 0.034).
  
  
  
  The combination therapy with vancomycin-loaded calcium sulfate and vancomycin-loaded PMMA possibly achieved more effective control of infection in the treatment of osteomyelitis through synergistic effect. The immediate structural stabilization and higher concentration of antibiotic at the local site of infection may be achieved through the combination of biodegradable and non-biodegradable devices in the treatment of chronic post-traumatic and postoperative osteomyelitis. The study was retrospectively registered at 11/16/2016 (TRN: NCT02968693).
authors.affiliation: Department of Orthopaedics Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, Guangxi, China.|Yulin Orthopedics Hospital of Chinese and Western Medicine, 537000, Yulin, Guangxi, China.
authors.forename: Shanchao
authors.initials: S
authors.lastname: Luo
authors.affiliation: Department of Orthopaedics Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, Guangxi, China.|Guangxi Engineering Center in Biomedical Materials for Tissue and Organ Regeneration, Guangxi Medical University, 530021, Nanning, Guangxi, China.
authors.forename: Tongmeng
authors.initials: T
authors.lastname: Jiang
authors.affiliation: Yulin Orthopedics Hospital of Chinese and Western Medicine, 537000, Yulin, Guangxi, China.
authors.forename: Yingnian
authors.initials: Y
authors.lastname: Yang
authors.affiliation: Yulin Orthopedics Hospital of Chinese and Western Medicine, 537000, Yulin, Guangxi, China.
authors.forename: Xiaoping
authors.initials: X
authors.lastname: Yang
authors.affiliation: Department of Orthopaedics Trauma and Hand Surgery, The First Affiliated Hospital of Guangxi Medical University, 530021, Nanning, Guangxi, China. zhaojinmin@126.com.|Guangxi Engineering Center in Biomedical Materials for Tissue and Organ Regeneration, Guangxi Medical University, 530021, Nanning, Guangxi, China. zhaojinmin@126.com.|Collaborative Innovation Center of Guangxi Biological Medicine, Guangxi Medical University, 530021, Nanning, Guangxi, China. zhaojinmin@126.com.|Guangxi Key Laboratory of Regenerative Medicine, Guangxi Medical University, 530021, Nanning, Guangxi, China. zhaojinmin@126.com.
authors.forename: Jinmin
authors.initials: J
authors.lastname: Zhao
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000900:Anti-Bacterial Agents / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D001842:Bone and Bones / Q000293:injuries; D002133:Calcium Sulfate / Q000009:adverse effects / Q000737:chemistry*; D016022:Case-Control Studies; D002908:Chronic Disease; D003646:Debridement; D004337:Drug Carriers / Q000009:adverse effects / Q000737:chemistry*; D016503:Drug Delivery Systems / Q000295:instrumentation*; D004351:Drug Resistance; D004359:Drug Therapy, Combination; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D019637:Orthopedic Procedures / Q000009:adverse effects; D010019:Osteomyelitis / Q000097:blood / Q000188:drug therapy* / Q000209:etiology / Q000601:surgery; D019904:Polymethyl Methacrylate / Q000009:adverse effects / Q000737:chemistry*; D011183:Postoperative Complications / Q000097:blood / Q000188:drug therapy* / Q000209:etiology; D012086:Reoperation; D012189:Retrospective Studies; D014640:Vancomycin / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D055815:Young Adult
chemical_list: D000900:Anti-Bacterial Agents; D004337:Drug Carriers; D014640:Vancomycin; D019904:Polymethyl Methacrylate; D002133:Calcium Sulfate
keywords: Antibiotic; Calcium Sulfate; Debridement; Level of Evidence Level III; Osteomyelitis; PMMA; Retrospective trial