Antibiotic bone cement coated implant effective and feasible primary treatment of infectious bone defects

Linhu Wang et al conducted a study to investigate the clinical efficacy of antibiotic bone cement-coated implants compared with external fixations for treating infected bone defects. It was conducted at ‘Department of Orthopaedics, Second Affliated Hospital, Air Force Medical University, Xinsi Rd, Xi, Shaanxi, China’. The article has been published in ‘International Orthopaedics.’

Infectious bone defects are mostly caused by open fractures with a serious contamination, infection after internal fixation of fractures, and haematogenous osteomyelitis. The treatment involves both infection control and repair of bone defects. It is a challenge for clinicians to repair bone defects in the presence of infection.

The authors retrospectively enrolled 119 patients with infected bone defects in our hospital, of which 56 were treated with antibiotic bone cement–coated implants and 63 were with external fixation.

The diagnosis of infected bone defects was mainly on the basis of history, signs, and symptoms including localized pain and swelling, imaging studies (X-ray, computed tomography, radionuclide bone scan, and magnetic resonance imaging) showing bone destruction or changes, microbiology, histopathology, and laboratory tests. The diagnosis was made after comprehensive consideration by clinicians, and the histopathological examination was the gold standard.

Key findings of the study were:

• The pre-operative and post-operative haematological indexes were tested to assess the infection control; the postoperative CRP level in the internal fixation group was lower than that in the external fixation group.

• No statistical significance was found in the rate of infection recurrence, loosening and rupture of the fixation, and amputation between the two groups.

• Twelve patients in the external fixation group had pin tract infection.

• In the evaluation of the Paley score scale, bone healing aspect revealed no significant difference between the two groups, while in the limb function aspect, antibiotic cement–coated implant group showed a much better score than the external fixation group (P=0.002).

• The most commonly isolated monomicrobial agent was Enterobacter cloacae in both groups

• The anxiety evaluation scale result also showed lower score in the antibiotic cement implant group (P <0.001).

The authors concluded that – “based on the results of the study, we believed that the antibiotic bone cement–coated implant was a feasible fixation method for the primary treatment of infectious bone defects. It could provide better limb stability and patient compliance and reduce the psychological burden of patients compared with the external fixation, thereby improving the patient’s quality of life without increasing the rate of infection recurrence.”

Further reading:

Efficacy comparison of antibiotic bone cement–coated implants and external fixations for treating infected bone defects. Linhu Wang, Shuaikun Lu et al, International Orthopaedics (2023) 47:1171–1179, https://doi.org/10.1007/s00264-023-05727-8