Authors: Maale, G. E., Casas-Ganem, J. E., Dallas Ft.Worth Sarcoma Group, Dallas, Texas
Title: The Use of Antibiotic Loaded Synthesized Calcium Sulfate Pellets In the One Stage Treatment for Osteomyelitis
Purpose: To show the low wound complication rate using a synthesized, highly purifed calcium sulfate antibiotc loaded pellet in the one stage treatment of infected total joints and osteomyelitis
Methods: Patients referred for treatment of infected total joints, joints,or osteomyelitis were pre-operatively imaged. The patients underwent radical debridement, followed by reconstruction of the involved area with 2 separate setups, at the same surgery. The definitive reconstruction was then performed utilizing antiobiotic loaded calcium sulfate pellets that had been synthesized, highly pure and at a nuetral PH. The antibiotic dose was 500 milligrams of vancomycin powder, and 240 milligrams of tobramycin suspension. The pellets were mixed on the clean setup side and hardened in 20 minutes. Drains were placed in infected total joints and patients with flaps and pulled 3-5 days post-op. Wound complications were recorded. X-rays were obtaine at 2-3 weeks to show dissolution of pellets in soft tissue.
Results: Fifty three patients were treated with the one stage debridement -reconstruction with addition of antibiotc loaded calcium sulfate pellets. Thirty patients were infected total joints and were treated with antibiotic loaded cement as well. They included 8 total hips, 17 vtotal knees, 1 Total elbow-humerus-shoulder, and 4 total hips-femurs-knees. In addition 23 patients had pellets alone, these included osteomyelitis involving 6 S-I joints, 3 tibias, 3 forearms 2 femurs,2 feet, and 1 ankle and 1 chest. Stumps from 2 BKA's, 1 AKA,, 1 hemipelvectomy, and 1 forequarter amputation. X-rays obtained demonstrated the pellets dissolved at 2-3 weeks. Three patients had wound complications, 2 requiring other drainswith irrigation procedures at 10-14 days, and a patient with total hip-femur -knee had a relapse of infection requiring amputation.
Discuassion and Conclusion: Antibiotic carriers for soft tissuemanagement of osteomyelitis, have been well accepted in he treatment strategy. Most common is the antibiotic loaded cement. Calcium sulfate when used as a carrier has a wound complication rate of between 25-30%. Described in this study is the use of a highly purified, synthetic, and biologic PH, calcium sulfate crystal with a standard antibiotic load that has low wound management problems,( < 6%)., and dissolves in 2-3 weeks. This may have application for one stage management of osteomyelitis where cement is undesirable for the reconstruction. Long term followup is clearly necessary as is elution profile and mechanisms of inhibition.