The role of bioceramics in the management of osteomyelitic voids

Abstract

Background: Bioceramics are gaining popularity as dead space management in chronic osteomyelitis. They are bioabsorbable, have good antimicrobial activity, promote bone healing, and have a low complication profile. Several bioceramics are available in South Africa. This study investigates our experience of bioceramics in terms of outcomes and complications in managing osteomyelitic dead space.

Methods: A retrospective review was conducted on bioceramics in the management of chronic osteomyelitis of the appendicular skeleton between January 2016 and November 2022. The bioceramics used as dead space management strategies are: bioactive glass (S53P4 - BonAlive Biomaterials), and antibiotic-impregnated bone substitutes, i.e. Cerament G/V (Bonesupport) or Osteoset with added gentamycin (Wright Medical Group).

Results: The final cohort comprised 90 patients with a mean age of 34 years. The mean follow-up was 12 months (12.7 ± 8.6). Most patients were classified as Cierny and Mader (C&M) type 3 (61%), followed by C&M type 4 (37%). A total recurrence rate of 3% was noted. The recurrence rate per bioceramic used was 0% for Osteoset, 2% for bioactive glass, and 5% for Cerament.

Conclusion: Bioceramics are a popular alternative to PMMA in the management of osteomyelitic voids, especially in the setting of single-stage surgery. Several bioceramics are currently available in South Africa. Outcomes of bioceramics in the management of chronic osteomyelitis are encouraging and in keeping with international literature.

Level of evidence: Level 2