Eluting antibiotic bone graft substitutes for the treatment of osteomyelitis in long bones. A review: evidence for their use?

Carsten W Schlickewei, Sinef Yarar, Johannes M Rueger Department of Trauma, Hand and Reconstructive Surgery, University Medical Center Hamburg-Eppendorf, Hamburg, Germany Abstract: Despite continuous advances in surgical procedures and antibiotic therapies, osteomyelitis still remains one of the most devastating complications in trauma and orthopedic surgery. Treatment of osteomyelitis represents a severe and challenging problem, even if the treatment of acute cases with systemic antibiotics has good success rates. Chronic cases need a consequent resection of dead or infected bone in addition to an improved systemic and local antibiotic therapy. The gold standard therapy is the implantation of polymethylmethacrylate as spacer and local antibiotic carrier. Besides other drawbacks, nonbiodegradable polymethylmethacrylate implants need to be removed. This led to an ongoing search for a biodegradable antibiotic bone graft substitute for the treatment of osteomyelitis to avoid secondary removal. The number of clinically available products grows, but still, the available number of peer-reviewed clinical trials to prove their efficiency is limited. This review gives an overview of the current available literature. Keywords: osteomyelitis, bone infection, eluting antibiotics, bone graft substitutes, antibiotic bone graf