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Gatti SD, Gaddi D, Turati M, Leone G, Arts JJ, Pessina F, Carminati M, Zatti G, De Rosa L, Bigoni M. Clinical outcomes and complications of S53P4 bioactive glass in chronic osteomyelitis and septic non-unions: a retrospective single-center study. Eur J Clin Microbiol Infect Dis 2024; 43:489-499. [PMID: 38195783 DOI: 10.1007/s10096-023-04737-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2023] [Accepted: 12/11/2023] [Indexed: 01/11/2024]
Abstract
INTRODUCTION Dead space management following debridement surgery in chronic osteomyelitis or septic non-unions is one of the most crucial and discussed steps for the success of the surgical treatment of these conditions. In this retrospective clinical study, we described the efficacy and safety profile of surgical debridement and local application of S53P4 bioactive glass (S53P4 BAG) in the treatment of bone infections. METHODS A consecutive single-center series of 38 patients with chronic osteomyelitis (24) and septic non-unions (14), treated with bioactive glass S53P4 as dead space management following surgical debridement between May 2015 and November 2020, were identified and evaluated retrospectively. RESULTS Infection eradication was reached in 22 out of 24 patients (91.7%) with chronic osteomyelitis. Eleven out of 14 patients (78.6%) with septic non-union achieved both fracture healing and infection healing in 9.1 ± 4.9 months. Three patients (7.9%) developed prolonged serous discharge with wound dehiscence but healed within 2 months with no further surgical intervention. Average patient follow-up time was 19.8 months ± 7.6 months. CONCLUSION S53P4 bioactive glass is an effective and safe therapeutic option in the treatment of chronic osteomyelitis and septic non-unions because of its unique antibacterial properties, but also for its ability to generate a growth response in the remaining healthy bone at the bone-glass interface.
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Affiliation(s)
| | - Diego Gaddi
- Department of Orthopedic Surgery, Policlinico San Pietro, Ponte San Pietro, Italy
| | - Marco Turati
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy.
- Orthopedic Department, IRCCS San Gerardo dei Tintori, Via Pergolesi, 33, 20900, Monza, Italy.
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France.
- Department of Paediatric Orthopedic Surgery, Hospital Couple Enfants, Grenoble Alpes University, Grenoble, France.
| | - Giulio Leone
- Orthopedic Department, IRCCS San Gerardo dei Tintori, Via Pergolesi, 33, 20900, Monza, Italy
| | - Jacobus J Arts
- Department Orthopaedic Biomechanics, Faculty Biomedical Engineering, Eindhoven University of Technology TU/e, Eindhoven, Netherlands
- Department Orthopaedic Surgery, Maastricht University Medical Centre, Maastricht, the Netherlands
| | - Fabio Pessina
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
| | - Mattia Carminati
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
| | - Giovanni Zatti
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
- Orthopedic Department, IRCCS San Gerardo dei Tintori, Via Pergolesi, 33, 20900, Monza, Italy
| | - Laura De Rosa
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
- Orthopedic Department, IRCCS San Gerardo dei Tintori, Via Pergolesi, 33, 20900, Monza, Italy
| | - Marco Bigoni
- School of Medicine and Surgery, University of Milano, Bicocca, Monza, Italy
- Department of Orthopedic Surgery, Policlinico San Pietro, Ponte San Pietro, Italy
- Transalpine Center of Pediatric Sports Medicine and Surgery, University of Milano-Bicocca - Hospital Couple Enfant, Monza (Italy), Grenoble, France
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Epstein G, Ferreira N. Dead space management strategies in the treatment of chronic osteomyelitis: a retrospective review. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY & TRAUMATOLOGY : ORTHOPEDIE TRAUMATOLOGIE 2023; 33:565-570. [PMID: 36112226 DOI: 10.1007/s00590-022-03392-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Accepted: 09/02/2022] [Indexed: 10/14/2022]
Abstract
PURPOSE Dead space management is critically important during the treatment of chronic osteomyelitis. Many dead space management strategies are available, each with their respective advantages and shortcomings. This study aims to present the outcomes and complications of dead space management strategies employed in the treatment of chronic osteomyelitis at a single tertiary level musculoskeletal unit. METHODS A retrospective review of dead space management strategies employed at a tertiary-level musculoskeletal infection unit was conducted. Patients of any age treated for chronic osteomyelitis of the appendicular skeleton with a minimum follow-up of 6 months were included in the study. Data were collected regarding patient demographics, aetiology and site of infection, dead space management strategy employed, follow-up period and outcome in terms of resolution of infection. RESULTS A final cohort of 132 patients underwent surgical treatment with a dedicated dead space management strategy for chronic osteomyelitis of the appendicular skeleton. Eleven patients (8%) experienced a recurrence of infection. Seven patients (63%) with recurrence were type B hosts, while four patients (37%) were type A hosts. CONCLUSION Dead space management is an integral part of treating chronic osteomyelitis; however, no guidelines currently exist regarding the most appropriate strategy. Favourable results are achievable in low to middle-income countries, and it is evident that no dead space management strategy is superior to another. The pursuit for the ideal void filler is ongoing. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Gadi Epstein
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa
| | - Nando Ferreira
- Division of Orthopaedic Surgery, Department of Surgical Sciences, Faculty of Medicine and Health Sciences, Stellenbosch University, Cape Town, South Africa.
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Shearer A, Montazerian M, Sly JJ, Hill RG, Mauro JC. Trends and perspectives on the commercialization of bioactive glasses. Acta Biomater 2023; 160:14-31. [PMID: 36804821 DOI: 10.1016/j.actbio.2023.02.020] [Citation(s) in RCA: 19] [Impact Index Per Article: 19.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/13/2022] [Revised: 02/08/2023] [Accepted: 02/09/2023] [Indexed: 02/18/2023]
Abstract
At least 25 bioactive glass (BG) medical devices have been approved for clinical use by global regulatory agencies. Diverse applications include monolithic implants, bone void fillers, dentin hypersensitivity agents, wound dressing, and cancer therapeutics. The morphology and delivery systems of bioactive glasses have evolved dramatically since the first devices based on 45S5 Bioglass®. The particle size of these devices has generally decreased with the evolution of bioactive glass technology but primarily lies in the micron size range. Morphologies have progressed from glass monoliths to granules, putties, and cements, allowing medical professionals greater flexibility and control. Compositions of these commercial materials have primarily relied on silicate-based systems with varying concentrations of sodium, calcium, and phosphorus. Furthermore, therapeutic ions have been investigated and show promise for greater control of biological stimulation of genetic processes and increased bioactivity. Some commercial products have exploited the borate and phosphate-based compositions for soft tissue repair/regeneration. Mesoporous BGs also promise anticancer therapies due to their ability to deliver drugs in combination with radiotherapy, photothermal therapy, and magnetic hyperthermia. The objective of this article is to critically discuss all clinically approved bioactive glass products. Understanding essential regulatory standards and rules for production is presented through a review of the commercialization process. The future of bioactive glasses, their promising applications, and the challenges are outlined. STATEMENT OF SIGNIFICANCE: Bioactive glasses have evolved into a wide range of products used to treat various medical conditions. They are non-equilibrium, non-crystalline materials that have been designed to induce specific biological activity. They can bond to bone and soft tissues and contribute to their regeneration. They are promising in combating pathogens and malignancies by delivering drugs, inorganic therapeutic ions, and heat for magnetic-induced hyperthermia or laser-induced phototherapy. This review addresses each bioactive glass product approved by regulatory agencies for clinical use. A review of the commercialization process is also provided with insight into critical regulatory standards and guidelines for manufacturing. Finally, a critical evaluation of the future of bioactive glass development, applications, and challenges are discussed.
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Affiliation(s)
- Adam Shearer
- Department of Materials Science and Engineering, The Pennsylvania State University, University Park, PA, USA
| | - Maziar Montazerian
- Northeastern Laboratory for Evaluation and Development of Biomaterials, Department of Materials Engineering, Federal University of Campina Grande, PB, Brazil
| | - Jessica J Sly
- Department of Materials Science and Engineering, The Pennsylvania State University, University Park, PA, USA
| | - Robert G Hill
- Institute of Dentistry, Dental Physical Sciences Unit, Queen Mary University of London, London, United Kingdom
| | - John C Mauro
- Department of Materials Science and Engineering, The Pennsylvania State University, University Park, PA, USA.
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Arshad Z, Lau EJS, Aslam A, Thahir A, Krkovic M. Management of chronic osteomyelitis of the femur and tibia: a scoping review. EFORT Open Rev 2021; 6:704-715. [PMID: 34667641 PMCID: PMC8489473 DOI: 10.1302/2058-5241.6.200136] [Citation(s) in RCA: 11] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
Osteomyelitis refers to an inflammatory process causing bone destruction and necrosis. Managing such a persistent disease is complex, with a number of authors reporting different techniques. This scoping review aims to map and summarize the literature on treatment of chronic femoral and tibial osteomyelitis, in order to improve the reader's understanding of potential treatments and identify areas of further research.The methodological framework of the Joanna Briggs Institute was followed. A computer-based search was conducted in PubMed, EMBASE, MEDLINE, EMCARE and CINAHL, for articles reporting treatment of chronic tibial/femoral osteomyelitis. Two reviewers independently performed title/abstract and full-text screening according to pre-defined criteria.A total of 1230 articles were identified, with 40 finally included. A range of treatments are reported, with the core principles being removal of infected tissue, dead-space management and antibiotic therapy. The majority (84.5%) of patients presented with stage III or IV disease according to the Cierny-Mader classification, and Staphylococcus aureus was the most commonly isolated organism. The proportion of patients achieving remission with no recurrence during follow-up varies from 67.7-100.0%.The majority of studies report excellent outcomes in terms of infection remission and lack of recurrence. However, identifying specific patient or treatment-related factors which may affect outcomes is currently challenging due to the nature of the included studies and unclear reporting of treatment outcomes. It is now important to address this issue and identify such factors using further high-level research methods such as randomized controlled trials and comparative cohort studies. Cite this article: EFORT Open Rev 2021;6:704-715. DOI: 10.1302/2058-5241.6.200136.
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Affiliation(s)
- Zaki Arshad
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | | | - Aiman Aslam
- University of Cambridge School of Clinical Medicine, Cambridge, UK
| | - Azeem Thahir
- Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge, UK
| | - Matija Krkovic
- Department of Trauma and Orthopaedic Surgery, Addenbrooke's Hospital, Cambridge, UK
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De Giglio R, Di Vieste G, Mondello T, Balduzzi G, Masserini B, Formenti I, Lodigiani S, Pallavicini D, Pintaudi B, Mazzone A. Efficacy and Safety of Bioactive Glass S53P4 as a Treatment for Diabetic Foot Osteomyelitis. J Foot Ankle Surg 2021; 60:292-296. [PMID: 33358382 DOI: 10.1053/j.jfas.2020.06.029] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2019] [Revised: 05/03/2020] [Accepted: 06/22/2020] [Indexed: 02/03/2023]
Abstract
Osteomyelitis represents a challenging condition in the diabetic foot with an associated high risk of major amputation. S53P4 Bioactive Glass (BG) has bacterial inhibiting properties on the market and indicated to be used in osteomyelitis. The objective of the study was to test the efficacy and safety of BG in treating diabetic foot osteomyelitis. This was an observational, retrospective, single-centre study involving subjects with diabetes affected by osteomyelitis of the foot who underwent surgical debridement from 01/2016 to 10/2018. Overall, 44 diabetic patients (14 [31.8%] female, aged 68.0 ± 10.2 years, diabetes duration 26.8 ± 11.9 years) were studied: 22 (50%) treated with surgical debridement and a local application of BG; 22 (50%) treated by means of surgical debridement. The primary outcome was the osteomyelitis resolution. Revascularization was performed before surgical procedure in 31 (70.5%) of patients. Systemic antibiotics were used in both groups. The osteomyelitis resolution rate was significantly higher in subjects treated with BG than in subjects treated with traditional procedure (18 [90%] vs 13 [61.9%], respectively p = .03). The odds of BG to reach osteomyelitis resolution was 5.54 times greater than for traditional treatment (odds ratio 5.54, 95% confidence interval 1.10-30.5). The use of BG was associated with an 81% lower probability to need additional antibiotic therapy compared to subjects treated with traditional procedure (odds ratio 0.19, 95% confidence interval 0.04-0.87). The debridement of osteomyelitis followed by application of BG could be an effective and safe option in the treatment of osteomyelitis of the diabetic foot.
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Affiliation(s)
- Roberto De Giglio
- Chief, Diabetic Foot Unit, ASST OVEST Milanese, Abbiategrasso Hospital, Milan, Italy.
| | - Giacoma Di Vieste
- Associate Physician, Diabetic Foot Unit, ASST OVEST Milanese, Abbiategrasso Hospital, Milan, Italy
| | - Teresa Mondello
- Associate Physician, Diabetic Foot Unit, ASST OVEST Milanese, Abbiategrasso Hospital, Milan, Italy
| | - Gianmario Balduzzi
- Doctor of Podiatric Medicine, Diabetic Foot Unit, ASST OVEST Milanese, Abbiategrasso Hospital, Milan, Italy
| | - Benedetta Masserini
- Associate Physician, Diabetic Foot Unit, ASST OVEST Milanese, Abbiategrasso Hospital, Milan, Italy
| | - Ilaria Formenti
- Associate Physician, Diabetic Foot Unit, ASST OVEST Milanese, Abbiategrasso Hospital, Milan, Italy
| | - Sara Lodigiani
- Associate Physician, Diabetic Foot Unit, ASST OVEST Milanese, Abbiategrasso Hospital, Milan, Italy
| | - Dario Pallavicini
- Associate Physician, Department of Radiology, Unit, ASST OVEST Milanese, Abbiategrasso Hospital, Milan, Italy
| | - Basilio Pintaudi
- Associate Physician, Diabetes Unit, Niguarda Hospital, Milan, Italy
| | - Antonino Mazzone
- Associate Professor and Director of Department of Internal Medicine, ASST OVEST Milanese, Legnano General Hospital, Milan, Italy
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Steinhausen E, Lefering R, Glombitza M, Brinkmann N, Vogel C, Mester B, Dudda M. Bioactive glass S53P4 vs. autologous bone graft for filling defects in patients with chronic osteomyelitis and infected non-unions - a single center experience. J Bone Jt Infect 2021; 6:73-83. [PMID: 34084694 PMCID: PMC8132459 DOI: 10.5194/jbji-6-73-2021] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2020] [Accepted: 12/17/2020] [Indexed: 11/29/2022] Open
Abstract
Introduction:
The goals of osteomyelitis therapy are successful control of infection and
reconstruction of the bone. The gold standard for filling defects is the
autologous bone graft. Bioactive glass S53P4 is an inorganic bone
substitute. We compared the outcome of using bioactive glass (BAG) versus
autologous bone graft (AB) in patients with infected non-union.
Methods:
Patients with chronic osteomyelitis and infected non-union who received
either bioactive glass or autologous bone grafts between 2013 and 2017 were
analyzed retrospectively. The primary endpoint was successful control of
infection during follow-up. Secondary endpoints were bone healing,
functional outcome, and occurrence of complications.
Results:
Eighty-three patients were analyzed (BAG n=51, AB n=32). Twenty-one
patients experienced reinfection (BAG n=15, 29 %; AB n=6, 19 %).
Seventy-eight patients achieved full weight bearing (BAG n=47, 92 %; AB
n=31, 97 %). Sixty-four patients had complete bone healing at the end of
the follow-up period (BAG n=39, 77 %; AB n=25, 78 %). There were no
significant differences between the groups with respect to the primary or
secondary endpoints. Patients with multidrug-resistant pathogens had a
significantly higher rate of incomplete bone healing (p=0.033) and a 3-fold
higher risk of complications in both groups.
Conclusions:
Bioactive glass appears to be a suitable bone substitute not only for
successful control of infection and defect filling but also for bone healing
in cases of infected non-union. In our study, bioactive glass was neither
superior nor inferior to autologous bone graft with regard to the primary
and secondary endpoints. Further studies with larger numbers of patients are
required.
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Affiliation(s)
- Eva Steinhausen
- Department of Orthopedic and Trauma Surgery, BG Klinikum Duisburg, University of Duisburg-Essen, 47249 Duisburg, Germany.,Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Rolf Lefering
- Institute for Research in Operative Medicine (IFOM), University of Witten/Herdecke, Cologne, Germany
| | - Martin Glombitza
- Department of Orthopedic and Trauma Surgery, BG Klinikum Duisburg, University of Duisburg-Essen, 47249 Duisburg, Germany
| | - Nikolaus Brinkmann
- Department of Orthopedic and Trauma Surgery, BG Klinikum Duisburg, University of Duisburg-Essen, 47249 Duisburg, Germany
| | - Carsten Vogel
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Bastian Mester
- Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
| | - Marcel Dudda
- Department of Orthopedic and Trauma Surgery, BG Klinikum Duisburg, University of Duisburg-Essen, 47249 Duisburg, Germany.,Department of Trauma, Hand and Reconstructive Surgery, University Hospital Essen, University of Duisburg-Essen, Essen, Germany
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Iacopi E, Pieruzzi L, Goretti C, Piaggesi A. Pilot Experience on the Use of S54P4 Bioactive Glass in the Surgical Management of Diabetic Foot Osteomyelitis. INT J LOW EXTR WOUND 2020; 21:57-64. [PMID: 32506987 DOI: 10.1177/1534734620926003] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
To test safety and efficacy of bioactive glass, a novel material used to replace bone, able to completely bond itself to the host tissues on patients treated for osteomyelitis (OM) complicating a diabetic foot (DF). We evaluated a group of patients consecutively admitted in our department between September and December 2018, who underwent surgical DF procedures for OM and in whom the use of bioactive glass could limit the demolition phase of surgical procedure. Patients were treated with bioactive glass S53P4 on top of standard treatment directly in operating room. The patients were weekly controlled for 6 months or until complete healing. During follow-up, we analyzed primarily healing rate and secondarily time of healing, need for further debridement procedures, recurrences, and adverse or hypersensitivity reactions to study treatment. Ten DF patients were enrolled (male/female 6/4; mean age 56 ± 11 years; mean duration of diabetes 10.5 ± 4.7 years, mean hemoglobin A1c 7.2 ± 0.9%). Patients underwent surgical procedure during which, after an accurate debridement, bioactive glass was applied. A healing rate of 80% in a mean time of 34 ± 2 days, with only 1 patient who needed a second surgical look, was observed. Neither recurrences nor adverse events during follow-up were observed in treated patients. This pilot experience demonstrated that bioactive glass can be considered a useful tool for the surgical treatment of DF-related OM.
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Affiliation(s)
- Elisabetta Iacopi
- Diabetic Foot Section, Department of Medicine, University of Pisa, Pisa, Italy
| | - Letizia Pieruzzi
- Diabetic Foot Section, Department of Medicine, University of Pisa, Pisa, Italy
| | - Chiara Goretti
- Diabetic Foot Section, Department of Medicine, University of Pisa, Pisa, Italy
| | - Alberto Piaggesi
- Diabetic Foot Section, Department of Medicine, University of Pisa, Pisa, Italy
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