SLR - October 2023 - Booth
Title: Mid- to long-term results of single- stage surgery for patients with chronic osteomyelitis using a bioabsorbable gentamicin-loaded ceramic carrierReference: McNally MA, Ferguson JY, Scarborough M, Ramsden A, Stubbs DA, Atkins BL. Mid- to long-term results of single-stage surgery for patients with chronic osteomyelitis using a bioabsorbable gentamicin-loaded ceramic carrier. Bone Joint J. 2022 Sep;104-B(9):1095-1100. doi: 10.1302/0301-620X.104B9.BJJ-2022-0396.R1. PMID: 36047024; PMCID: PMC9948464.
Reviewed By: Mitchell Booth, DPM
Residency Program: Presbyterian / St. Luke’s Medical Center, Denver, Colorado
Podiatric Relevance: Chronic osteomyelitis is an increasingly common condition treated by foot and ankle surgeons. There may be hesitance to perform a single-stage closure after excision of infected tissue, thus delayed primary closures are often performed. Animal studies have suggested local antibiotic delivery may decrease rate of infection. The authors postulate that a biphasic ceramic delivery of gentamicin would be effective in humans. This study evaluates the outcomes of patients with chronic osteomyelitis treated with local and systemic antibiotics.
Methods: Patients presenting with Cierny-Mader Type III or IV chronic osteomyelitis were recruited between March 2013 to February 2015. These patients were treated with a single-stage procedure including excision of infected tissue and application of Cerament G to fill bony defects. All patients also received oral or intravenous antibiotics for 6-12 weeks. The primary measured outcome was presence of infection.
Results: Of the 100 patients included in the study, 6% had recurrent infection at a mean follow-up of 6.05 years. Recurrence was not significantly related to the physiological class of the patient, presence of nonunion, etiology of infection, specific organisms cultured, or presence of a gentamicin-resistant organism. Gentamicin-resistant organisms were found to be more prevalent in polymicrobial infections compared to monobacterial osteomyelitis.
Conclusions: The findings from this article suggest that there are many cases of chronic osteomyelitis that can be successfully treated with a single-stage procedure through the use of a local antibiotic delivery system. Although many of these cases are treated with delayed primary closure, it is possible that healthcare costs and hospital length of stay may be reduced through the use of a single-stage procedure.