Treatment of Osteomyelitis with Antibiotic-Soaked Porous A-W Glass Ceramic Blocks

We have developed a new drug delivery system using porous apatite-wollastonite glass ceramic (A-W GC) to treat osteomyelitis and used for clinical cases. The porous A-W GC block (porosity: 70%, 4 mm in diameter and 4 mm long) and Isepamicin Sulfate (ISP) solution (100 mg/ml) were placed in 30 ml syringe and the A-W GC columns were soaked with the antibiotics using handy vacuum method. Eleven patients with infected total hip arthroplasty, two with infected total knee arthroplasty and two with osteomyelitis of tibia were treated using the antibiotic-soaked porous glass ceramic. The postoperative observation periods were from nine months to six years and eight months (average 3y and 8m), and infection was calmed down finally except for one case of MRSA. The value of CRP had become 0.5 or less in all cases at last follow-up, when one case of rheumatoid arthritis patient was removed. Although 13 joints, which do not have revision operation, two cases show stem loosening but are under observation because of less pain. Our clinical study showed that antibiotic-soaked A-W GC blocks appeared to be useful for the treatment of chronic osteomyelitis or infected arthroplasties with bone defects. Introduction Chronic osteomyelitis is difficult to treat due to the characteristics of bone and the object in treating osteomyelitis is to maintain bactericidal concentration of antibiotic at the infection focus long enough for the healing process to begin. Various antibiotic carrier systems have been developed, including one in which bone cement was mixed with antibiotic-impregnated polymethylmethacrylate (PMMA) beads [1]. However, the problem with the use of PMMA beads inserted locally was that subsequent surgery was required for replacement with an autograft. In recently, drug delivery system (DDS) using resorbable, collagen, tricalcium phosphate, Key Engineering Materials Online: 2003-05-15 ISSN: 1662-9795, Vols. 240-242, pp 253-256 doi:10.4028/www.scientific. net/KEM.240-242.253 © 2003 Trans Tech Publications Ltd, Switzerland All rights reserved. No part of contents of this paper may be reproduced or transmitted in any form or by any means without the written permission of Trans Tech Publications Ltd, www.scientific. net. (Semanticscholar.org-13/03/20,21:20:36) fibrinogen and polylactic acid [2] have been developed. Although it is not necessary to remove them, it might take a long time or never happen to fill the infection site with new bone without bone grafting. We have developed a new DDS using of antibiotic soaked porous A-W GC block, which was demonstrated previously to form a chemical bond with living bone, and used it clinically. Materials and Methods The porous A-W glass ceramic (A-W GC) columns (porosity: 70%, 4 mm in diameter and 4 mm long) and Isepamicin Sulfate (ISP) solution (100 mg/ml) were placed in 30 ml syringe and the A-W GC columns were soaked with antibiotics using handy vacuum method. Eleven patients with infected total hip arthroplasty, two with infected total knee arthroplasty and two with osteomyelitis of tibia were treated using the antibiotic-soaked porous glass ceramic. The average follow-up term was 43.9 months. In 13 patients with infected arthroplasty, 11 total hip arthroplasty (THA) and 2 total knee arthroplasty (TKA), one stage revision surgery was performed. After curettage of the infected focus, a large bone defect was filled with the antibiotic-soaked ceramic. The socket was fixed with Kerboull cross shell and antibiotic-impregnated PMMA bone cement and the femoral stem also was fixed with antibiotic-impregnated PMMA cement using antibiotic-soaked ceramic blocks as cement plug in THA revision surgery. In TKA patients, revision surgery was performed using rotating hinge type TKA. The two patients with osteomyelitis of tibia were treated with two stages operation, in which the first stage was curettage the infected focus and the antibiotic-soaked ceramic blocks were implanted into the defect in the second operation after continuous irrigation for two weeks.