Synthetic bone replacement materials used for one-stage treatment of chronic osteomyelitis

Introduction. The paper presents a comparative analysis of one-stage treatment of chronic osteomyelitis using tobramycin-impregnated calcium sulfate and β-tricalcium phosphate mixed with antibiotics impregnated hydroxyapatite to fill in the cavitary defect of long bones.

Material and methods. The retrospective group (group 1, n = 34) was treated with tobramycin-impregnated calcium sulfate (Osteoset T), and the prospective group (group 2, n = 25) received β-tricalcium phosphate mixed with antibiotics impregnated hydroxyapatite (ReproBone).

Results and discussion. There were no significant differences between the groups of patients by gender, age, type of osteomyelitis and duration of the disease. The differences in the operating time, intraoperative blood loss and the size of the cavitary bone defect post debridement were not significant between the groups. There were no significant differences in preoperative level of CRP between the groups, with CRP being higher (p = 0.02) in group 1 than in group 2, prior to the discharge from the hospital. Recurrence was seen in 35 % (n = 12) of group 1 and in 16 % (n = 4) of group 2 at a 21/2-year follow-up. The risk of recurrence was found to be 2.2 times greater with use of commercially available biocomposite loaded with tobramycin that that with β-tricalcium phosphate mixed with hydroxyapatite (HR 2.206; CI 0.806-6.038) impregnated with antibiotics administered with preoperative microbiological findings.

Conclusion. Combined β-tricalcium phosphate based biocomposites mixed with hydroxyapatite impregnated with broad-spectrum antibiotics showed greater efficacy for methicillin-resistant staphylococcus aureus in the treatment of chronic osteomyelitis filling cavitary bone defect of long bones as comp ared to tobramycin-impregnated calcium sulfate.

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