Bioactive glass S53P4 vs. autologous bone graft for filling defects in patients with chronic osteomyelitis and infected non-unions – a single center experience

Abstract

Abstract. Introduction: The goals of osteomyelitis therapy are successful control of infection and reconstruction of the bone. The gold standard for filling defects is the autologous bone graft. Bioactive glass S53P4 is an inorganic bone substitute. We compared the outcome of using bioactive glass (BAG) versus autologous bone graft (AB) in patients with infected non-union. Methods: Patients with chronic osteomyelitis and infected non-union who received either bioactive glass or autologous bone grafts between 2013 and 2017 were analyzed retrospectively. The primary endpoint was successful control of infection during follow-up. Secondary endpoints were bone healing, functional outcome, and occurrence of complications. Results: Eighty-three patients were analyzed (BAG n=51, AB n=32). Twenty-one patients experienced reinfection (BAG n=15, 29 %; AB n=6, 19 %). Seventy-eight patients achieved full weight bearing (BAG n=47, 92 %; AB n=31, 97 %). Sixty-four patients had complete bone healing at the end of the follow-up period (BAG n=39, 77 %; AB n=25, 78 %). There were no significant differences between the groups with respect to the primary or secondary endpoints. Patients with multidrug-resistant pathogens had a significantly higher rate of incomplete bone healing (p=0.033) and a 3-fold higher risk of complications in both groups. Conclusions: Bioactive glass appears to be a suitable bone substitute not only for successful control of infection and defect filling but also for bone healing in cases of infected non-union. In our study, bioactive glass was neither superior nor inferior to autologous bone graft with regard to the primary and secondary endpoints. Further studies with larger numbers of patients are required.

Comment on “Bioactive glass S53P4 vs. autologous bone graft for filling defects in patients with chronic osteomyelitis and infected non-unions – a single center experience” by Steinhausen et al. (2021)

“…In 1931, Jacob Kulowski published his classical series of 130 cases of osteomyelitis, treated by Orr's method (Kulowski, 1931). His surgical debridement technique was similar to that described by Steinhausen et al (2021), and he achieved a recurrence rate of 24 % (mean follow-up: 19 months), in the pre-antibiotic era, with no defect fillers. In this new series of 83 patients, the recurrence rate with bioglass was 29 % and 19 % for ABG.…”

“…I read with interest the recent paper by Steinhausen et al (2021). This paper reports the outcome of a retrospective review of bioactive glass compared to autologous bone graft (ABG) in a staged surgical protocol for treating established bone infection.…”

“…In contrast to bioglass, the use of local antimicrobials may allow reduced systemic therapy and better antibiotic stewardship (Masrouha et al, 2018;Dudareva et al, 2019). Steinhausen et al (2021) also claim that "The tolerability of BAG is even described as superior when compared to other bone substitutes". We cannot find any evidence for this statement in their paper.…”

Reply to McNally's comment on “Bioactive glass S53P4 vs. autologous bone graft for filling defects in patients with chronic osteomyelitis and infected non-unions – a single center experience” by Steinhausen et al. (2021)

“…First, we will describe the differences between the patient collectives of the Zeitschrift für Orthopädie und Unfallchirurgie (ZOU) paper (Malat et al, 2018) and the current Journal of Bone and Joint Infection (JBJI) paper (Steinhausen et al, 2021).…”

“…However, there are studies that prove the antibacterial effect of BAG without addition of local antibiotics. Van Vugt et al (2016) evaluated the use of various bone graft substitutes in a systematic review. No significant differences were found between the different bone graft substitutes (with and without adjunctive use of local antibiotics).…”