Vol 32| Issue 2 | July – Dec 2019 | page: 14-19 | Ahamad Shaheel Sultan, Joseph Dickson Olivero
Authors: Ahamad Shaheel Sultan , Joseph Dickson Olivero 
 Department Of Orthopaedics, Govt. Medical College, Kozhikode, Kerala, India.
 Department Of Orthopaedics, IQRAA International Hospital Calicut, Kerala, India.
Address of Correspondence
Dr. Raju Karuppal,
Govt. Medical College, Kozhikode, Kerala, India.
Introduction: Chronic orthopedic infections are always a nightmare not only in developing world but also in developed nations. They will always persist to be a continuing challenge for any orthopedic surgeon. Debridement is the answer and not to sit on any infection neglecting if any. Surgical aim and irrigation are to dilute the bug concentration for a viable vascularized base which helps healing. Local antibiotic delivery system always stood the test of time. The principle involved is achieving a germ-free environment locally, leading to better and faster union of fracture.
Objectives: The objectives of the study were to study the efficacy of biodegradable calcium sulfate impregnated antibiotic beads in treating chronic osteomyelitis and to study any adverse effect of biodegradable calcium sulfate impregnated antibiotic beads in the treatment of chronic osteomyelitis.
Materials and Methods: This is a prospective study conducted in Government T D Medical College Hospital from August 2017 to August 2019.Our sample size of 100 patients was included meeting consenting for the study and meeting inclusion and exclusion criteria. Efficacy of the biodegradable antibiotic beads was measured using the following parameters for all selected patients: (1) Clinical parameters (ASEPSIS scoring system),(2) radiological parameters(Cierny and Mader staging), (3) laboratory parameters(erythrocyte sedimentation rate and C-reactive protein), and (4) culture results (discharge/pus)
Results: There were 75 males and25 females out of 100 selected patients.
Functional Outcome: While comparing clinical, radiological, and laboratory parameters, 80 patients had good results and 20 had bad outcome.
Complication: Product-related discharge in 5 patients, persistence of osteomyelitis in 10 patients, and persistence of non-union in 5 patients.
Conclusion: Local application of antibiotic-impregnated biodegradable calcium sulfate beads has better outcome in the treatment of chronic orthopedic infections.
Keywords: Chronic orthopedic infections, Antibiotic beads, Biodegradable antibiotic beads, Cierny-Mader staging.
1. Evans RP, NelsonCL. Gentamicin-impregnated polymethylmethacrylate beads compared with systemic antibiotic therapy in the treatment of chronic osteomyelitis.ClinOrthopRelat Res1993;295:37-42.
2. WimmerMD, RandauTM, FriedrichMJ, PloegerMM, SchmolderJ, StraussAC, et al. Outcome predictors in prosthetic joint infections–validation of a risk stratification score for prosthetic joint infections in 120 cases.ActaOrthopBelg2016;82:143-8.
3. vande Belt H, NeutD, SchenkW, vanHorn JR, vander Mei HC, BusscherHJ. Infection of orthopedic implants and the use of antibiotic-loaded bone cements. A review.ActaOrthopScand2001;72:557-71.
4. QiuXS, ChenYX, QiXY, ShiHF, WangJF, XiongJ. Outcomes of cement beads and cement spacers in the treatment of bone defects associated with post-traumatic osteomyelitis.BMC MusculoskeletDisord2017;18:256.
5. KinikH, KaradumanM. Cierny-Mader Type III chronic osteomyelitis: The results of patients treated with debridement, irrigation, vancomycin beads and systemic antibiotics.IntOrthop2008;32:551-8.
6. BörzseiL, MintálT, KoósZ, KocsisB, HelyesZ, KereskaiL, et al. Examination of a novel, specified local antibiotic therapy through polymethylmethacrylate capsules in a rabbit osteomyelitis model.Chemotherapy2006;52:73-9.
7. Blaha JD, Calhoun JH, Nelson CL, Henry SL, Seligson D, Esterhai JL Jr., et al. Comparison of the clinical efficacy and tolerance of gentamicin PMMA beads on surgical wire versus combined and systemic therapy for osteomyelitis.Clin Orthop Relat Res1993;295:8-12.
8. BowyerGW, CumberlandN. Antibiotic release from impregnated pellets and beads.J Trauma1994;36:331-5.
9. DahnersLE, FunderburkCH. Gentamicin-loaded plaster of Paris as a treatment of experimental osteomyelitis in rabbits.Clin Orthop Relat Res1987;219:278-82.
10. EvansRP, NelsonCL. Gentamicin-impregnated polymethylmethacrylate beads compared with systemic antibiotic therapy in the treatment of chronic osteomyelitis.Clin Orthop Relat Res1993;295:37-42.
11. EvrardJ, KerriO, MartiniM, ConortO. Treatment of bone infection by plaster of Paris pellets impregnated with antibiotics.Pathol Biol (Paris)1990;38:543-7.
12. GitelisS, PiaseckiP, TurnerT, HaggardW, ChartersJ, UrbanR. Use of a calcium sulfate-based bone graft substitute for benign bone lesions.Orthopedics2001;24:162-6.
13. WahligH, DingeldeinE, BergmannR, ReussK. The release of gentamicin from polymethylmethacrylate beads. An experimental and pharmacokinetic study.J Bone Joint Surg Br1978;60-B:270-5.
14. MeyerJD, FalkRF, KellyRM, ShivelyJE, WithrowSJ, DernellWS, et al. Preparation and in vitro characterization of gentamycin-impregnated biodegradable beads suitable for treatment of osteomyelitis.J Pharm Sci1998;87:1149-54.
15. CiampoliniJ, HardingKG. Pathophysiology of chronic bacterial osteomyelitis. Why do antibiotics fail so often?Postgrad Med J2000;76:479-83.
16. ZalavrasCG, PatzakisMJ, HoltomP. Local antibiotic therapy in the treatment of open fractures and osteomyelitis.Clin Orthop Relat Res2004;427:86-93.
17. SeligsonD, MehtaS, VoosK, HenrySL, JohnsonJR. The use of antibiotic-impregnated polymethylmethacrylate beads to prevent the evolution of localized infection.J Orthop Trauma1992;6:401-6.
18. WahligH, DingeldeinE, BergmannR, ReussK. The release of gentamicin from polymethylmethacrylate beads. An experimental and pharmacokinetic study.J Bone Joint Surg Br1978;60-B:270-5.
19. SpangehlMJ, MasriBA, O’ConnellJX, DuncanCP. Prospective analysis of preoperative and intraoperative investigations for the diagnosis of infection at the sites of two hundred and two revision total hip arthroplasties.J Bone Joint Surg Am1999;81:672-83.
20. WangS. Antibiotic-impregnated cement temporary spacer for surgical treatment of osteomyelitis and nonunion of bone caused by intramedullary nailing.Zhongguo Xiu Fu Chong Jian Wai Ke Za Zhi2011;25:972-5.
21. MousaHA. Evaluation of sinus-track cultures in chronic bone infection.J Bone Joint Surg Br1997;79:567-9.
22. KlemmKW. Antibiotic bead chains.Clin Orthop Relat Res1993;295:63-76.
23. ShyamAK, SanchetiPK, PatelSK, RochaS, PradhanC, PatilA. Use of antibiotic cement-impregnated intramedullary nail in treatment of infected non-union of long bones.Indian J Orthop2009;43:396-402.
24. QiangZ, JunPZ, JieXJ, HangL, BingLJ, CaiLF. Use of antibiotic cement rod to treat intramedullary infection after nailing: Preliminary study in 19 patients.Arch Orthop Trauma Surg2007;127:945-51.
25. PennerMJ, MasriBA, DuncanCP. Elution characteristics of vancomycin and tobramycin combined in acrylic bone-cement.J Arthroplasty1996;11:939-44.
|How to Cite this Article: Sultan A S, Olivero J D | Efficacy of Biodegradable Calcium Sulfate Impregnated Gentamycin Beads for the Management of Chronic Osteomyelitis | Kerala Journal of Orthopaedics | July – Dec 2019; 32(2): 14-19 .