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Review
. 2022 Jun;125(6):452-459.
doi: 10.1007/s00113-022-01185-w. Epub 2022 May 11.

[Augmentation in surgical sepsis : Chances and limitations in the treatment of osteitis with calcium hydroxyapatite containing antibiotics]

[Article in German]
H Freischmidt  1 , G Reiter  1 , P A Grützner  1 , J Armbruster  2
Affiliations
Review

[Augmentation in surgical sepsis : Chances and limitations in the treatment of osteitis with calcium hydroxyapatite containing antibiotics]

[Article in German]
H Freischmidt et al. Unfallchirurgie (Heidelb). 2022 Jun.

Abstract
in English, German

Background: The surgical treatment of osteitis or fracture-related infections (FRI) is often associated with large bone defects. The treatment of these defects remains a major challenge in trauma surgery. Within the concept of tissue engineering, the development of various hybrid bone graft substitutes, such as calcium hydroxyapatite with added antibiotics, is continuously progressing.

Objective: Chances and limitations in the treatment of osteitis with calcium hydroxyapatite containing antibiotics.

Material and methods: Overview of the results of a 2-stage (infection) pseudarthrosis model on rat femurs treated with Cerament® G (Bonesupport, Lund, Schweden). Evaluation of the clinical experiences based on three case examples of osteitis treated with calcium hydroxyapatite containing antibiotics (Cerament® G or Cerament® V).

Results: After establishment of a 2‑stage pseudarthrosis model on the rat femur, the osteoconductive and osteoinductive potential of calcium hydroxyapatite containing antibiotics could be confirmed. In the clinical application, the use of Cerament® G seems to lead to a more favorable outcome in small cavitary defects. The recurrence rates are higher than previously described, especially for larger segmental defects.

Conclusion: Taking the clinical and experimental results into consideration, a stricter evaluation of the indications for the use of Cerament® G is necessary to achieve the best possible outcome for patients.

Zusammenfassung: HINTERGRUND: Die operative Behandlung von Osteitiden bzw. frakturbedingen Infektionen (FRI) ist häufig mit großen Knochendefekten assoziiert. Die Therapie dieser Knochendefekte stellt die Unfallchirurgie weiterhin vor große Herausforderungen. Im Rahmen des „Tissueengineering“ schreitet die Entwicklung unterschiedlicher hybrider Knochenersatzstoffe, wie z. B. antibiotikahaltigem Kalziumhydroxylapatit, stetig voran.

Fragestellung: Chancen und Limitationen in der Behandlung der Osteitis mit antibiotikahaltigem Kalziumhydroxylapatit.

Material und methoden: Übersicht der Ergebnisse eines mit Cerament® G (Fa. Bonesupport, Lund, Schweden) therapierten zweizeitigen (Infekt‑)Pseudarthrosen-Modells am Rattenfemur. Evaluation der klinischen Erfahrungen anhand von 3 Fallbeispielen zur Behandlung von Osteitiden mit antibiotikahaltigem Kalziumhydroxylapatit (Cerament® G oder Cerament® V).

Ergebnisse: Nach Etablierung eines zweizeitigen Pseudarthrosenmodells am Rattenfemur konnte das osteokonduktive und osteoinduktive Potenzial von antibiotikahaltigem Kalziumhydroxylapatit (Cerament®) nachgewiesen werden. In der klinischen Anwendung erscheint der Einsatz von Cerament® eher bei kleineren, kavitären Defekten erfolgversprechender. Die Rezidivraten, insbesondere bei größeren segmentalen Defekten, sind höher als zuvor beschrieben.

Schlussfolgerungen: In Anbetracht der klinischen und experimentellen Ergebnisse ist eine engere Indikationsstellung für den Einsatz von Cerament® notwendig, um das bestmögliche Outcome des Patienten zu erreichen.

Keywords: Calcium hydroxyapatite; Gentamicin; Infected non-union; Osteitis; Parathormone.

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References

Literatur

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