Bioactive glass S53P4 to fill-up large cavitary bone defect after acute and chronic osteomyelitis treated with antibiotic-loaded cement beads: A prospective case series with a minimum 2-year follow-up.

Autor: Kojima KE; Trauma Service, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil. Electronic address: kodi.kojima@hc.fm.usp.br., de Andrade E Silva FB; Trauma Service, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil., Leonhardt MC; Trauma Service, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil., de Carvalho VC; Infectious Disease Service, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil., de Oliveira PRD; Infectious Disease Service, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil., Lima ALLM; Infectious Disease Service, Instituto de Ortopedia e Traumatologia, Hospital das Clínicas HCFMUSP, Universidade de São Paulo, São Paulo, SP, Brazil., Roberto Dos Reis P; Trauma Service, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil., Silva JDS; Trauma Service, Instituto de Ortopedia e Traumatologia, Hospital das Clinicas HCFMUSP, Faculdade de Medicina, Universidade de Sao Paulo, São Paulo, SP, Brazil.
Jazyk: angličtina
Zdroj: Injury [Injury] 2021 Jul; Vol. 52 Suppl 3, pp. S23-S28. Date of Electronic Publication: 2021 Jun 01.
DOI: 10.1016/j.injury.2021.05.030
Abstrakt: Introduction: Bioactive glass S53P4 (BAG-S53P4) has been used in the treatment of osteomyelitis with excellent results. The aim of this study was to evaluate the clinical and radiographic results of patients treated with use of antibiotic-loaded cement beads, followed by bone defects filling using bioglass.
Methods: We treated a prospective series of patients presenting with acute or chronic osteomyelitis of a long bone of the upper or lower limb. The first-stage procedure involved debridement and filling of cavitary defects with antibiotic-loaded polymethylmethacrylate (PMMA) beads. When signs of infection subsided, the defects were filled with BAG-S53P4. The main outcomes assessed were the reinfection rate, need for reoperation, radiographic and functional evaluations (DASH and Lysholm scores).
Results: Ten patients were included, aged between 4 and 66 years (mean 25.4 years). The source of infection was hematogenic in five cases and post-traumatic in the other five. Hematogenic infections required two debridements before filling with bioglass, whereas post-traumatic cases required only one. The time between the first debridement and the application of bioglass varied from 1 to 63 weeks (average of 17 weeks). All patients showed a favorable evolution after bioglass procedure, with no need for reoperation or relevant wound problems. The radiographic evaluation showed partial incorporation of the material and adequate bone formation, and functional scores were satisfactory in all cases.
Conclusion: The treatment of osteomyelitis with surgical debridement and PMMA beads, followed by filling of bone defect with BAG-S53P4, was effective in all patients evaluated, with adequate infectious control and bone regeneration. No cases required reoperation after bioglass implantation. Patients with hematogenous osteomyelitis required a greater number of debridements before filling with bioglass.
Competing Interests: Declaration of Competing Interest None of the authors received payments or services, either directly or indirectly (i.e., via his or her institution), from a third party in support of any aspect of this work. No author has had any relationships, or has engaged in any activities, that could be perceived to influence or have the potential to influence what is written in this work.
(Copyright © 2021. Published by Elsevier Ltd.)
Databáze: MEDLINE
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