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Evaluation of Indigenous Antibiotic Impregnated Cement Rod in the treatment of chronic osteomyelitis of long bones

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Original Article

Author Details : Yogesh R. Gaikwad, Vijay V. Nemade, Vijayanad R. Lokhande, Shardul M. Soman, Sandeep D. Shinde

Volume : 3, Issue : 4, Year : 2017

Article Page : 360-365

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Abstract

Introduction: Management of chronic osteomyelitis demands prolonged Antibiotic therapy. Antibiotics may be administered systemically or locally. Local antibiotic therapies have definite advantages. In this study we used Indigenous Antibiotic Impregnated malleable PMMA Cement Rod. Aim of this study is to evaluate the efficacy of Indigenous Antibiotic Impregnated Malleable PMMA Cement Rod in the treatment of chronic osteomyelitis of long bones.
Methods: This study involved retrospective evaluation of 63 patients of chronic osteomyelitis of long bones treated at our institute between February 2011 to January 2016. All patients with chronic osteomyelitis of long bones with less than 2 cm of sequestrum formation were included in the study. Patients with infected non-union were treated with other modalities of treatment and were excluded from the study. Initially for first three years we treated 33 patients of chronic osteomyelitis of long bones with surgical removal of infected and dead bone and soft tissue followed by local Antibiotics Impregnated PMMA Beads. These patients were considered as Group A. Later since February 2014 we started treating patients with Indigenous Antibiotic Impregnated Malleable PMMA Cement Rod and these patients were considered as Group B. 
Results: There were 33 patients in group A. 26 patients cured with complete irradication of the infection. Cultures performed on tissue sample taken at the time of Beads removal were negative in these cases. In 9 patients removal of Beads was difficult. 7 patients had persistent pain, swelling and inflammation. On investigations they had raised CRP, Total count and Neutrophillia. They all underwent second surgical procedure - removal of Beads and further treatment with Masquelet technique. One of these 7 patients had pathological fracture which was stabilized with Antibiotic impregnated PMMA intramedullary nail. These 7 cases required 16 to 23 weeks for complete cure of infection. The average time required for complete recovery in Group A patients was 17 weeks. There were 30 patients in group B. All patients were completely cured in a mean time period of 8 weeks (range, 6–11 weeks). No patient required a second surgical procedure to achievecontrol of infection. Tissue samples obtained at the time of Rod removal showed no growth on culture in all these patients. 
Conclusion: Our study results demonstratesvery effective and complete cure of chronic osteomyelitis in less time period with the use of Indigenous Antibiotic Impregnated Cement Rod technique as against the use of Antibiotic Impregnated Cement Beads.

Keywords: Indigenous Antibiotic Impregnated Cement Rod, chronic osteomyelitis, Antibiotic PMMA Beads

How to cite : Gaikwad Y R, Nemade V V, Lokhande V R, Soman S M, Shinde S D, Evaluation of Indigenous Antibiotic Impregnated Cement Rod in the treatment of chronic osteomyelitis of long bones. Indian J Orthop Surg 2017;3(4):360-365

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