Advertisement

Comparison of the use of antibiotic-loaded calcium sulphate and wound irrigation-suction in the treatment of lower limb chronic osteomyelitis

  • Author Footnotes
    1 Cheng-He Qin, Hong-An Zhang and Yu-Han Chee contributed equally to this paper.
    Cheng-He Qin
    Correspondence
    Corresponding author.
    Footnotes
    1 Cheng-He Qin, Hong-An Zhang and Yu-Han Chee contributed equally to this paper.
    Affiliations
    Department of Orthopaedics and Traumatology, Guangdong Second Provincial General Hospital, The Second Clinical Medical School of Southern Medical University, Guangzhou, 510317, PR China
    Search for articles by this author
  • Author Footnotes
    1 Cheng-He Qin, Hong-An Zhang and Yu-Han Chee contributed equally to this paper.
    Hong-An Zhang
    Footnotes
    1 Cheng-He Qin, Hong-An Zhang and Yu-Han Chee contributed equally to this paper.
    Affiliations
    Nanfang Hospital, Southern Medical University, Guangzhou, 510515, PR China
    Search for articles by this author
  • Author Footnotes
    1 Cheng-He Qin, Hong-An Zhang and Yu-Han Chee contributed equally to this paper.
    Yu-Han Chee
    Footnotes
    1 Cheng-He Qin, Hong-An Zhang and Yu-Han Chee contributed equally to this paper.
    Affiliations
    Department of Orthopaedics, National University Hospital Singapore, Singapore
    Search for articles by this author
  • Astuti Pitarini
    Affiliations
    Department of Orthopaedics, National University Hospital Singapore, Singapore
    Search for articles by this author
  • Abdulnassir Adem Ali
    Affiliations
    Nanfang Hospital, Southern Medical University, Guangzhou, 510515, PR China
    Search for articles by this author
  • Author Footnotes
    1 Cheng-He Qin, Hong-An Zhang and Yu-Han Chee contributed equally to this paper.
Published:October 29, 2018DOI:https://doi.org/10.1016/j.injury.2018.10.036

      Highlights

      • The first study to compare antibiotic-loaded calcium sulphate and irrigation-suction in treating chronic osteomyelitis.
      • Present high infection recurrence and docking obstruction rate of irrigation-suction.
      • Present potential inductivity of calcium sulphate.

      Abstract

      Aims

      We sought to compare the efficacy of antibiotic-loaded calcium sulphate with wound irrigation-suction in patients with lower limb chronic osteomyelitis.

      Patients and methods

      Adult patients with lower limb chronic osteomyelitis treated at our hospital by means of segmental bone resection, antibiotic-loaded calcium sulphate implantation or wound irrigation-suction, followed by bone transport with external fixator from January 2011 to July 2015 were retrospectively evaluated. The clinical presentation, laboratory results, complications, docking obstruction, infection recurrence were compared.

      Results

      There were totally 74 patients met the inclusion criteria. Docking obstruction rate and infection recurrence were higher in the irrigation group with significant difference. The success rate of the first operation was 90.74% in the calcium sulphate group compared with 45% in the irrigation group. Postoperaton leakage of the incision happened more in the calcium sulphate group, but it wasn’t a risk factor for docking obstruction and infection recurrence. Patients in the calcium sulphate group had shorter hospital stay and systemic antibiotic treatment, also with less external fixator index.

      Conclusions

      The findings of our study suggest that antibiotic-loaded calcium sulphate implantation for lower chronic limb osteomyelitis was a more successful method than wound irrigation-suction, it greatly decreased infection recurrence and docking obstruction. Postoperative leakage after implantation didn’t worsen patient’s outcome.

      Keywords

      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to Injury
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Assadian O.
        • Kammerlander G.
        • Geyrhofer C.
        • Luch G.
        • Doppler S.
        • Tuchmann F.
        • et al.
        Use of wet-to-moist cleansing with different irrigaton solutions to reduce bacterial bioburden in chronic wounds.
        J Wound Care. 2018; 27: S10-S16
        • Bahrs C.
        • Schnabel M.
        • Frank T.
        • Zapf C.
        • Mutters R.
        • Von Garrel T.
        Lavage of contaminated surfaces: an in vitro evaluation of the effectiveness of different systems.
        J Surg Res. 2003; 112: 26-30
        • Barker A.T.
        • Dixon R.A.
        • Sharrard W.J.
        • Sutcliffe M.L.
        Pulsed magnetic field therapy for tibial non-union. Interim results of a double-blind trial.
        Lancet. 1984; 1: 994-996
        • Beuerlein M.J.
        • McKee M.D.
        Calcium sulfates: what is the evidence?.
        J Orthop Trauma. 2010; 24: S46-S51
        • Claes L.
        • Ruter A.
        • Mayr E.
        Low-intensity ultrasound enhances maturation of callus after segmental transport.
        Clin Orthop Relat Res. 2005; : 189-194
        • Costerton J.W.
        • Stewart P.S.
        • Greenberg E.P.
        Bacterial biofilms: a common cause of persistent infections.
        SCIENCE. 1999; 284: 1318-1322
        • Geurts J.
        • Chris A.J.
        • Walenkamp G.H.
        Bone graft substitutes in active or suspected infection. Contra-indicated or not?.
        Injury. 2011; 42: S82-S86
        • Giotakis N.
        • Narayan B.
        • Nayagam S.
        Distraction osteogenesis and nonunion of the docking site: is there an ideal treatment option?.
        Injury. 2007; 38: S100-S107
        • Golightly L.K.
        • Branigan T.
        Surgical antibiotic irrigations.
        Hosp Pharm. 1989; 24: 116-119
        • Hatzokos I.
        • Stavridis S.I.
        • Iosifidou E.
        • Karataglis D.
        • Christodoulou A.
        Autologous bone marrow grafting combined with demineralized bone matrix improves consolidation of docking site after distraction osteogenesis.
        J Bone Joint Surg Am. 2011; 93: 671-678
        • Jiang N.
        • Qin C.H.
        • Ma Y.F.
        • Wang L.
        • Yu B.
        Possibility of one-stage surgery to reconstruct bone defects using the modified Masquelet technique with degradable calcium sulfate as a cement spacer: a case report and hypothesis.
        Biomed Rep. 2016; 4: 374-378
        • Koyonos L.
        • Zmistowski B.
        • Della V.C.
        • Parvizi J.
        Infection control rate of irrigation and debridement for periprosthetic joint infection.
        Clin Orthop Relat Res. 2011; 469: 3043-3048
        • Lew D.P.
        • Waldvogel F.A.
        Osteomyelitis.
        Lancet. 2004; 364: 369-379
        • López-Pliego E.M.
        • Mora-Macías J.
        • Giráldez-Sánchez M.Á.
        • Domínguez J.
        • Reina-Romo E.
        Histological study of the docking site after bone transport. Temporal evolution in a sheep model.
        Injury. 2018;
        • Lovisetti G.
        • Sala F.
        • Thabet A.M.
        • Catagni M.A.
        • Singh S.
        Osteocutaneous thermal necrosis of the leg salvaged by TSF/Ilizarov reconstruction. Report of 7 patients.
        Int Orthop. 2011; 35: 121-126
        • Ma Y.F.
        • Jiang N.
        • Zhang X.
        • Qin C.H.
        • Wang L.
        • Hu Y.J.
        • et al.
        Calcium sulfate induced versus PMMA-induced membrane in a critical-sized femoral defect in a rat model.
        Sci Rer-UK. 2018; 8
        • Maffulli N.
        • Papalia R.
        • Zampogna B.
        • Torre G.
        • Albo E.
        • Denaro V.
        The management of osteomyelitis in the adult.
        Surgeon. 2016; 14: 345-360
        • Mah T.C.
        • O’Toole G.A.
        Mechanisms of biofilm resistance to antimicrobial agents.
        Trends Microbiol. 2001; 9: 34-39
        • McConoughey S.J.
        • Howlin R.P.
        • Wiseman J.
        • Stoodley P.
        • Calhoun J.H.
        Comparing PMMA and calcium sulfate as carriers for the local delivery of antibiotics to infected surgical sites.
        J Biomed Mater Res B Appl Biomater. 2015; 103: 870-877
        • McNally M.A.
        • Ferguson J.Y.
        • Lau A.C.
        • Diefenbeck M.
        • Scarborough M.
        • Ramsden A.J.
        • et al.
        Single-stage treatment of chronic osteomyelitis with a new absorbable, gentamicin-loaded, calcium sulphate/hydroxyapatite biocomposite: a prospective series of 100 cases.
        Bone Joint J. 2016; 98-B: 1289-1296
        • Nandi S.K.
        • Bandyopadhyay S.
        • Das P.
        • Samanta I.
        • Mukherjee P.
        • Roy S.
        • et al.
        Understanding osteomyelitis and its treatment through local drug delivery system.
        Biotechnol Adv. 2016; 34: 1305-1317
        • Nickel J.C.
        • Ruseska I.
        • Wright J.B.
        • Costerton J.W.
        Tobramycin resistance of Pseudomonas aeruginosa cells growing as a biofilm on urinary catheter material.
        Antimicrob Agents Chemother. 1985; 27: 619-624
        • Park S.H.
        • Silva M.
        • Bahk W.J.
        • McKellop H.
        • Lieberman J.R.
        Effect of repeated irrigation and debridement on fracture healing in an animal model.
        J Orthop Res. 2002; 20: 1197-1204
        • Roilides E.
        • Simitsopoulou M.
        • Katragkou A.
        • Walsh T.J.
        How biofilms evade host defenses.
        Microbiol Spectr. 2015; 3
        • Romanò C.L.
        • Logoluso N.
        • Meani E.
        • Romanò D.
        • De Vecchi E.
        • Vassena C.
        • et al.
        A comparative study of the use of bioactive glass S53P4 and antibiotic-loaded calcium-based bone substitutes in the treatment of chronic osteomyelitis: a retrospective comparative study.
        Bone Joint J. 2014; 96-B: 845-850
        • Roth B.
        • Neuenschwander R.
        • Brill F.
        • Wurmitzer F.
        • Wegner C.
        • Assadian O.
        • et al.
        Effect of antiseptic irrigation on infection rates of traumatic soft tissue wounds: a longitudinal cohort study.
        J Wound Care. 2017; 26: 79-87
        • Sala F.
        • Marinoni E.
        • Miller A.N.
        • Pesenti G.
        • Castelli F.
        • Alati S.
        • et al.
        Evaluation of an endoscopic procedure for the treatment of docking site nonunion.
        J Orthop Trauma. 2013; 27: 569-575
        • Sala F.
        • Thabet A.M.
        • Castelli F.
        • Miller A.N.
        • Capitani D.
        • Lovisetti G.
        • et al.
        Bone transport for postinfectious segmental tibial bone defects with a combined ilizarov/taylor spatial frame technique.
        J Orthop Trauma. 2011; 25: 162-168
        • Sanders J.
        • Mauffrey C.
        Long bone osteomyelitis in adults: fundamental concepts and current techniques.
        Orthopedics. 2013; 36: 368-375
        • Takaoka S.
        • Yamaguchi T.
        • Yano S.
        • Yamauchi M.
        • Sugimoto T.
        The Calcium-sensing Receptor (CaR) is involved in strontium ranelate-induced osteoblast differentiation and mineralization.
        Horm Metab Res. 2010; 42: 627-631
        • Tetsworth K.
        • Paley D.
        • Sen C.
        • Jaffe M.
        • Maar D.C.
        • Glatt V.
        • et al.
        Bone transport versus acute shortening for the management of infected tibial non-unions with bone defects.
        Injury. 2017; 48: 2276-2284
        • Thomas M.V.
        • Puleo D.A.
        Calcium sulfate: properties and clinical applications.
        J Biomed Mater Res B Appl Biomater. 2009; 88: 597-610
        • Timmers M.S.
        • Graafland N.
        • Bernards A.T.
        • Nelissen R.G.
        • Van Dissel J.T.
        • Jukema G.N.
        Negative pressure wound treatment with polyvinyl alcohol foam and polyhexanide antiseptic solution instillation in posttraumatic osteomyelitis.
        Wound Repair Regen. 2009; 17: 278-286
        • Winkler H.
        Rationale for one stage exchange of infected hip replacement using uncemented implants and antibiotic impregnated bone graft.
        Int J Med Sci. 2009; 6: 247-252
        • Yamaguchi T.
        • Chattopadhyay N.
        • Kifor O.
        • Sanders J.L.
        • Brown E.M.
        Activation of p42/44 and p38 mitogen-activated protein kinases by extracellular calcium-sensing receptor agonists induces mitogenic responses in the mouse osteoblastic MC3T3-E1 cell line.
        Biochem Bioph Res Co. 2000; 279: 363-368
        • Zimmerli W.
        • Sendi P.
        Orthopaedic biofilm infections.
        APMIS. 2017; 125: 353-364