The Treatment of Chronic Osteomyelitis with a Biodegradable Antibiotic-Impregnated Implant

Abstract

The use of local antibiotics from a biodegradable implant for chronic osteomyelitis is an attractive alternative. The implant delivers high tissue levels, obliterates dead space, aids bone repair and does not need to be removed. The purpose of this paper is to review our early clinical experience with custom-made calcium sulfate (Osteoset bone void filler) antibioticimpregnated implants.

Preliminary in vitro evaluation of an adjunctive therapy for extremity wound infection reduction: Rapidly resorbing local antibiotic delivery

“…Similar research on the conventional, uncrushed pellets, which are designed to elute antibiotic over a period of 28 days and used clinically to eradicate an existing infection, release concentrations of roughly 1,000 mg/ml/g over the first 24 h and 10 mg/ml/g over the next 24 h, sufficient levels to prevent antibiotic growth for weeks. 9,14,18,28,29 With such immediate antibiotic elution from conventional flakes, the in vitro work of this study does not suggest that a large difference in initial antibiotic concentration would occur between flakes and an injection. 7 Comparing the characteristics for the FAST pellet and the conventional flakes by Yarboro, we found that the FAST pellet dissolved more quickly and eluted antibiotic at a more sustained rate.…”

“…2,5,[7][8][9][13][14][15][16]19 We evaluated the dissolution, elution, and biological activity of fastdegrading drug delivery vehicles made from cellulose binder and calcium sulfate dihydrate and from conventional calcium sulfate alpha-hemihydrate crushed into flakes. While this study used the Yarboro-type crushed conventional cast antibiotic-loaded calcium sulfate pellet as a comparison, the crushing/compressing of commercially available calcium sulfate pellets with tobramycin is not recommended by the manufacturer.…”

“…The antibiotic solution was poured over 20.0 g calcium sulfate alpha-hemihydrate (calcium sulfate hemihydrate; Wright Medical Technology, Arlington, TN), and mixed briskly for 1 min. 9,14,18,19 The resulting 4% antibiotic-loaded paste was cast into silicone elastomer molds and left to dry overnight at room temperature. The pellets were then demolded and sterilized again using low-dose gamma irradiation (25 kGy).…”

“…12,13 Calcium sulfate, optimized to resorb at a rate similar to that of new bone formation (several weeks to months) has been combined with antibiotics to eradicate existing bone infections in clinical and experimental situations. 2,5,[7][8][9][13][14][15][16] A calcium sulfate pellet, engineered to dissolve and elute antibiotic over a shorter period of time, may be advantageous for infection prevention.…”

Heparinized nanohydroxyapatite/collagen granules for controlled release of vancomycin

“…23,24 Moreover, the size of the granules is also adequate to perform in vivo studies using an osteomyelitis rat model. 25 SEM images revealed the presence of interconnective macroporosity, which is desirable for bone tissue regeneration, as interconnectivity allows cell migration, neovascularization, and transport of nutrients and proteins.…”