A comparative study of the use of bioactive glass S53P4 and antibiotic-loaded calcium-based bone substitutes in the treatment of chronic osteomyelitis

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.

Influence of bioactive glass S53P4 granules and putty on osteomyelitis associated bacteria in vitro

“…BAG S53P4 has been used as bone graft substitute in the treatment of chronic osteomyelitis, according to a one-stage procedure with very promising resuts [21]. The obvious antibacterial effect of the BAG S53P4 granules contributes to the beneficial outcome of the treatment of this severe chronic infection [32,33,38]. Without the need of local antibiotics the potential risk of developing bacterial resistance is also decreased.…”

“…BAG S53P4 has been studied clinically in randomised prospective trials in bone tumour [27,28], trauma [29] and spine surgery [30,31]. Due to its antibacterial properties is has also been used in the treatment of severe chronic osteomyelitis, mastoiditis, spine infections and frontal sinus infections [21,[32][33][34][35][36][37][38].…”

Ceramic Biocomposites as Biodegradable Antibiotic Carriers in the Treatment of Bone Infections

“…Several writers have also published their outcomes for treating chronic osteomyelitis in humans with ceramic antibiotic carriers 9,16-22.…”

“…This has been implicated in causing some local wound issues, with serous ooze in a proportion of cases 16,20,22, although this seems to be self-limiting 21.…”

Reengineering autologous bone grafts with the stem cell activator WNT3A

“…For example, synthetic scaffolds such as ceramics (e.g., tricalcium phosphate, hydroxyapatite) and bioactive glass (silica and calcium oxide) have been fabricated to resemble the micro-porosity and compressive strength of bone [14,15]. While these synthetic materials are generally considered biocompatible, they exhibit no inherent osteogenic activity [16] and cannot adapt to changing physiologic conditions [17].…”