Abstract. Introduction: Current methods of managing osteomyelitic voids
after debridement are inadequate and result in significant morbidity to
patients. Synthetic ceramic void fillers are appropriate for non-infected
bone defects but serve as a nidus of re-infection in osteomyelitis after
debridement. CERAMENT G (CG) is an injectable ceramic bone void filler which contains gentamicin and is currently being evaluated for use in
osteomyelitic environments after debridement due to its theoretical ability
to serve as a scaffold for healing while eliminating residual bacteria after
debridement through the elution of antibiotics. The goal of this study was
to evaluate (1) the rate of persistent infection and (2) new bone growth of
a debrided osteomyelitic defect in a rat model which has been treated with
either gentamicin-impregnated ceramic cement (CERAMENT G) or the
same void filler without antibiotics (CERAMENT, CBVF). Methods: Osteomyelitis was generated in the proximal tibia of
Sprague Dawley rats, subsequently debrided, and the defect filled with
either (1) CG (n=20), (2) CBVF (n=20), or (3) nothing (n=20). Each group
was euthanized after 6 weeks. Infection was detected through bacterial
culture and histology. Bone growth was quantified using microCT.
Results: Infection was not detected in defects treated with CG
as compared with 35 % of defects (7/20) treated with CBVF and 50 %
(10/20) of empty defects (p=0.001). Bone volume in the defect of
CG-treated rats was greater than the CBVF (0.21 vs. 0.17, p=0.021) and
empty groups (0.21 vs. 0.11, p<0.001) at 6 weeks after
implantation.
Conclusions: Ceramic void filler with gentamicin
(CERAMENT G) decreased the rate of persistent infection and
increased new bone growth as compared to the same void filler without
antibiotics (CERAMENT) and an empty defect in a rat model of debrided osteomyelitis.