With Antibiotic Cement Versus Without Antibiotic Cement in the Treatment of Tibial Osteomyelitis After Radical Debridement: A Randomized Controlled Trial

Abstract

Background: In most of the cases, antibiotic cement is recommended to fill the dead space after debridement of osteomyelitis. As to local Cierny-Mader Type IV tibial osteomyelitis, radical debridement of the infected bone can be achieved, after that, is it still necessary to apply antibiotic cement to the dead space? This study was aimed to answer the question.Methods: From January 2010 to January 2015, 64 patients with local Cierny-Mader Type IV tibial osteomyelitis were included and randomly divided into two groups. Patients in the cement group were treated with antibiotic-impregnated bone cement after radical debridement of the infected bone (cement group), while the other patients in the without cement group were not applied any cement after the same debridement (without cement group). Both groups were operated by the same surgical team and applied Ilizarov bone transport to fill the bone defect.Result: All patients in both groups achieved successful healing with bone union at both corticotomy and tibial docking sites. At the end of follow-up，there was one case of infection recurrence in each groups. There were no differences in demographics and clinical variables between the two groups. There was also no difference either in terms of bone results or functional results between the two groups (c 2=0.006 for bone results and c 2=1.339 for functional results). But there was significant difference in terms of total hospitalization expenses between the two groups (P＜0.001, the cement group was much higher than the without cement group).Conclusion: When radical debridement is achieved in dealing with local Cierny-Mader Type IV tibial osteomyelitis, it is no need to apply antibiotics cement in the dead space, but it needs more cases to increase the convincingness.Trial registration: ChiCTR-TNRC-10002837，retrospectively registered.