May 21, 2014
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Study: Good outcomes associated with use of bone graft substitute

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Use of an injectable antibiotic eluting bone substitute as an off-the-shelf defect filler in patients with osteomyelitis was safe and associated with good clinical outcomes, according to results of a recently presented study.

Between March 2013 and November 2013, Martin McNally, an honorary senior clinical lecturer at the University of Oxford and lead surgeon of the Bone Infection Unit at the Nuffield Orthopaedic Centre in Oxford, England, and colleagues treated 41 patients with debridement, implantation of an injectable antibiotic eluting bone substitute (Cerament G, Bonesupport, Lund, Sweden) and soft tissue closure and systemic antibiotics. They measured serum gentamicin levels and assessed clinical and radiographic outcomes.

Researchers measured no toxic levels of gentamicin in the bloodstream and no patients had allergic or wound reactions. Two patients had self-limiting fluid leakage – one patient for 9 days and the other patient for 6 weeks. By performing serial X-rays immediately after surgery, at 6 weeks, 12 weeks, 6 months and 1 year, researchers found that 75% of the bones had complete filling of the defect and no patients had a recurrence during the 13-month follow-up.

Although the study produced promising early results, it was designed to study a limited group of patients, McNally said.

‘The early results are really very good, but we want to follow this one on,” McNally told Orthopedics Today.

He said the next step is to evaluate the injectable bone substitute in other areas of bone infection, as well as in patients with diabetes and foot infections. Additionally, the results need to be followed up for 1 year to 2 years for every patient to look at late recurrence and late formation of bone. The researchers also plan to study different antibiotics in the material, such as vancomycin, which is used for MRSA and other resistant organisms.

“Bone infection is under the radar a lot. It doesn’t get the headlines like cancer and heart disease, but worldwide it affects a vast number of people. A lot of people in the developing world who suffer an open fracture will develop an infection. They do not get the care which is available in Europe and North America and so they will have lifelong chronic infection,” McNally said. – by Casey Tingle

Reference:

McNally M. A prospective evaluation of Cerament G bone void filler with gentamicin in the treatment of chronic osteomyelitis with cavitary defects. Presented at: Oxford Bone Infection Annual Conference; April 3-4, 2014; Oxford, England.

Disclosure: McNally has received travel and accommodation expenses from Bonesupport.