Bioactive glass, a new tool for the treatment in the diabetic foot recalcitrant osteomyelitis: A case series with 24-month follow-up

BACKGROUND

The bioactive glass (BAG) is a promising solution for the reconstruction of bone defects and the eradication of infection in patients with osteomyelitis, however references to the treatment of diabetic foot osteomyelitis are scarce in the literature.

METHODS

Our experience in patients with diabetic foot osteomyelitis, who required surgical debridement and void filling, in which we use bioactive glass (n = 6), was evaluated. During a minimum follow-up of 24 months, the presence of persistent infection and healing rate, post-surgical complications, surgical reinterventions, degree of osseointegration and BAG-related side effects was analyzed.

RESULTS

At the end of the follow-up, none of the patients showed signs of persistent infection and the healing rate was 66.6% (4/6). Postoperative complications were noted in 3 patients and two of the them required new surgical intervention, both due to skin coverage or vascular complications. A complete osseointegration in the 66.6% of the patients and no cases of local adverse effects were recorded.

CONCLUSIONS

The bioactive glass can be a useful tool in the treatment of certain cases of diabetic foot osteomyelitis, provided that a multidisciplinary approach and strict patient selection is in place.

LEVEL OF EVIDENCE

IV.

Bilateral tibial Brodie's abscess in a young patient treated with BAG-S53P4: case report

Background

Brodie’s abscess is a form of chronic pyogenic osteomyelitis that usually affects the cancellous part of the long bones in children. Its treatment is represented by antibiotic therapy alone or in association with surgical procedures.

Case presentation

A 12-years-old male affected by a Brodie’s abscess of the tibia involving the distal growth plate was admitted to the Pediatric Department for a conservative treatment. After several attempts of antibiotic therapy interrupted for intolerance manifestations he was surgically treated with bioactive glass BAG-S53P4 (BonAlive, BonAlive Biomaterials Ltd., Biolinja, Finland), with excellent results.

Conclusions

In our experience BAG-S53P4 has proven to be an effective bone substitute without side effects even in the pediatric population. In our case it eradicated the infection without interfere with the growth; neither epiphysiodesis nor other disorders were found during the follow-up.

For the publication of this case report we followed the CARE guidelines for good clinical case reports; the parents gave consent for publication.

BAG-S53P4 as bone graft extender and antimicrobial activity against gentamicin- and vancomycin-resistant bacteria

AIM

To evaluate the suitability of bioactive glass (BAG)-S53P4 as a bone-graft extender for large bony defect filling in bone and joint infection.

MATERIALS & METHODS

Antimicrobial activity of BAG-S53P4 against clinically relevant strains isolated from bone and joint infections was evaluated by means of time-kill curves in presence of bone graft. Furthermore, the susceptibility to BAG of strains resistant to vancomycin and gentamicin was assessed.

RESULTS

Though attenuated, BAG maintains a good in vitro antimicrobial activity in presence of human body fluids and tissues contained in bone graft, with the exception of Enterococcus faecalis.

CONCLUSION

BAG-S53P4 is a suitable bone substitute that can be used as an extender with autologous bone graft to promote better fusion and healing.

BAG-S53P4 as an additive to bone allografts: A laboratory study using an uniaxial compression test

We want to address the clinical issue of too sparse supply of allograft in total hip replacement and ambitions of controlling the grain size distribution. Bioglass BAG-S53P4 was evaluated as a bone graft additive to chemically treated allografts with controlled grain size distribution. Allografts were chemically cleaned (CG) and mixed with BAG-S53P4 additive (BG) for comparison. All samples were compacted with a dropped weight apparatus and then underwent a uniaxial compression test. The yield limit was determined by a uniaxial compression test and density was recorded while flowability was calculated. There was no difference between the yield stress limit of BG and CG after compaction (p=0.432). Adding BAG-S53P4 reduced flowability and could indicate better interlocking mechanism between particles. Adding BAG-S53P4 seems to have no impact on the yield stress limit. The extended allografts withstand the compaction equally good which makes it a valid bone substitute in total hip replacement. An in vivo loaded study is needed before clinical use can be recommended.