The Use of Bioactive Glass S53P4 as Bone Graft Substitute in the Treatment of Chronic Osteomyelitis and Infected Non-Unions – a Retrospective Study of 50 Patients

Malat, T. Al; Glombitza, Martin; Dahmen, Janosch; Hax, P.-M.; Steinhausen, Eva

doi:10.1055/s-0043-124377

Cited by 30 publications

(21 citation statements)

References 30 publications

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“…For example in the treatment of osteomyelitis, usually bigger sized granules are used (Hulsen et al, 2017 ). Good clinical results have been obtained in the treatment of infections with the S53P4 granules (McAndrew et al, 2013 ; Geurts et al, 2016 ; Lindfors et al, 2016 ; Al Malat et al, 2018 ). During the treatment of osteomyelitis extensive debridement and cleaning is performed, the defect is fully packed with BAG granules, and additional systemic antibiotics are administered (Geurts et al, 2016 ; Lindfors et al, 2016 ).…”

Section: Discussionmentioning

confidence: 99%

Assessment of Growth Reduction of Five Clinical Pathogens by Injectable S53P4 Bioactive Glass Material Formulations

Thijssen

Gestel

Bevers

et al. 2020

Front. Bioeng. Biotechnol.

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The one-stage treatment of chronic osteomyelitis with S53P4 bioactive glass (BAG) granules has shown excellent results. However, these granules possess suboptimal handling properties. Therefore, new injectable S53P4 putty materials have been developed by the incorporation of a synthetic binder to contain glass granules. The goal of the current study was to assess their potential to eradicate five clinically relevant pathogens: methicillin sensitive Staphylococcus aureus (MSSA), methicillin resistant Staphylococcus aureus (MRSA), Enterococcus coli (E. coli), Enterococcus faecalis (E. faecalis), and Pseudomonas aeruginosa (P. aeruginosa). As a control, S53P4 granules (500-800 µm) and S66 glass (< 45 µm) were used. To evaluate the antimicrobial properties, the materials were cultured with the pathogens in a Müller-Hinton II broth for a week with daily colony forming unit (CFU) counting. One of the tested putty formulations was observed to reduce the number of CFU/mL compared to a negative control (no material, only pathogen in broth) for E. coli, E. faecalis and P. aeruginosa. However, none of the tested putty formulations was able to completely eradicate the pathogens in the broths, which would be needed for safe infection treatment. The results obtained for the control materials were unexpected. S66 glass showed full eradication of P. aeruginosa and reduced the number of CFUs of other pathogens, while the S53P4 granules did not show eradication. The observations on the loose S53P4 granules in this study contradict available literature, which needs further investigation. The results obtained in this study also stretch the importance for a better understanding of the underlying antimicrobial mechanism of S53P4 BAG and how this is related to the dosage. In addition, it should be elucidated how these antimicrobial properties are affected by changes in the material formulation, for example by addition of binders to improve the handling properties or by changing the surface area.

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Section: Discussionmentioning

confidence: 99%

Assessment of Growth Reduction of Five Clinical Pathogens by Injectable S53P4 Bioactive Glass Material Formulations

Thijssen

Gestel

Bevers

et al. 2020

Front. Bioeng. Biotechnol.

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“…BGs have a wide range of clinical applications for the reparation and reconstruction of bone, thus have been a preferential biomaterial for modification with Bi composites. 543,546,547 BGs have the ability to serve as an eluting agent of relevant therapeutics, contributing to therapeutic strategies against diseases such as osteomyelitis and bone cancer, 543,[548][549][550][551] particularly when combined with Bi as one the main components. Regarding the treatment of osteomyelitis, BGs by which the addition of Bi ions renders them with antimicrobial activity and promoted bone regeneration were investigated by Prasad et al 546 They demonstrated a combinatorial antibacterial effect and cell proliferation induction due to the combined action of antibacterial Bi 3+ ions and an increase in the pH value of the surrounding medium caused by the BG.…”

Section: Bi-based Biomaterials For Tissue Engineering and Implantationmentioning

confidence: 99%

The versatile biomedical applications of bismuth-based nanoparticles and composites: therapeutic, diagnostic, biosensing, and regenerative properties

et al. 2020

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Studies of nanosized forms of bismuth (Bi)-containing materials have recently expanded from optical, chemical, electronic, and engineering fields towards biomedicine, as a result of their safety, cost-effective fabrication processes, large surface area, high stability, and high versatility in terms of shape, size, and porosity. Bi, as a nontoxic and inexpensive diamagnetic heavy metal, has been used for the fabrication of various nanoparticles (NPs) with unique structural, physicochemical, and compositional features to combine various properties, such as a favourably high X-ray attenuation coefficient and near-infrared (NIR) absorbance, excellent light-to-heat conversion efficiency, and a long circulation half-life. These features have rendered bismuth-containing nanoparticles (BiNPs) with desirable performance for combined cancer therapy, photothermal and radiation therapy (RT), multimodal imaging, theranostics, drug delivery, biosensing, and tissue engineering. Bismuth oxyhalides (BiO x , where X is Cl, Br or I) and bismuth chalcogenides, including bismuth oxide, bismuth sulfide, bismuth selenide, and bismuth telluride, have been heavily investigated for therapeutic purposes. The pharmacokinetics of these BiNPs can be easily improved via the facile modification of their surfaces with biocompatible polymers and proteins, resulting in enhanced colloidal stability, extended blood circulation, and reduced toxicity. Desirable antibacterial effects, bone regeneration potential, and tumor growth suppression under NIR laser radiation are the main biomedical research areas involving BiNPs that have opened up a new paradigm for their future clinical translation. This review emphasizes the synthesis and state-of-the-art progress related to the biomedical applications of BiNPs with different structures, sizes, and compositions. Furthermore, a comprehensive discussion focusing on challenges and future opportunities is presented.

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“…The reinfection rate of patients with chronic osteomyelitis is reportedly as high as 21.2 % (Walenkamp et al, 1998), and the overall reinfection rate after implantation of BAG is 0 %-14 % according to the current literature (Romano et al, 2014;van Gestel et al, 2015;Lindfors et al, 2017Lindfors et al, , 2010McAndrew et al, 2013;Drago et al, 2013;Malat et al, 2018;Tanwar and Ferreira, 2020). We saw higher reinfections rates, especially in the BAG group.…”

Section: Control Of Infectionmentioning

confidence: 48%

“…Some studies have investigated the use of BAG in patients with chronic osteomyelitis. However, the number of cases in these studies was usually small, and most had no control group (Romano et al, 2014;Lindfors et al, 2017Lindfors et al, , 2010Auregan and Begue, 2015;McAndrew et al, 2013;Drago et al, 2013;Malat et al, 2018;Oosthuysen et al, 2020). Existing comparative studies compare BAG either with other bone substitutes (Table 4) or with PMMA beads (the gold standard for a two-stage procedure) and with the objective of investigating successful control of infection and dead space management of bone cavities, but not bone healing.…”

Section: Discussionmentioning

confidence: 99%

“…Our rate of complete osseous fusion is 77.1 % without significant difference between the groups at latest follow-up. Published studies do not report comparable rates (Romano et al, 2014;van Gestel et al, 2015;Lindfors et al, 2017;Ferrando et al, 2017;Lindfors et al, 2010;McAndrew et al, 2013;Drago et al, 2013). This is unsurprising because these studies investigated the use of BAG only as a bone void filler in chronic osteomyelitis.…”

Section: Bone Healing and Mobilization With Full Weight Bearingmentioning

confidence: 98%

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

Steinhausen

Lefering

Glombitza

et al. 2021

J. Bone Joint Infect.

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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.

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The Use of Bioactive Glass S53P4 as Bone Graft Substitute in the Treatment of Chronic Osteomyelitis and Infected Non-Unions – a Retrospective Study of 50 Patients

Abstract: TRN DRKS00011679.

Cited by 30 publications

References 30 publications

Assessment of Growth Reduction of Five Clinical Pathogens by Injectable S53P4 Bioactive Glass Material Formulations

Assessment of Growth Reduction of Five Clinical Pathogens by Injectable S53P4 Bioactive Glass Material Formulations

The versatile biomedical applications of bismuth-based nanoparticles and composites: therapeutic, diagnostic, biosensing, and regenerative properties

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

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