Infection / osteomyelitis

Osteomyelitis is an infection of bone or bone marrow with a concomitant inflammation involving the bone marrow and the surrounding tissues. These infections can originate from many different mechanisms.1 In the many years that passed since the first reported osteomyelitis, the knowledge about these infections increased significantly.2 Nowadays, we know that a common cause of osteomyelitis is a bacterial infection, for instance, the infection with Staphylococcus aureus after surgical intervention. Osteomyelitis isa major complication in orthopaedic surgery and is usually associated with open fracture surgery, bone reconstruction surgery, or orthopaedic implants.1 Despite the numerous cases of osteomyelitis in orthopaedic surgery there is no precise epidemiological data available, but in literature the incidence of osteomyelitis ranges from 1% in primary hip replacement up to 55% in treatment of type III open fractures.3-6 Appropriate treatment of patients with osteomyelitis is necessary because osteomyelitis can become chronic or is associated with delayed union or nonunion of fractures or failure of prosthesis implantation. In more severe untreated osteomyelitis bone sequestration, sinus formations or sepsis can cause disabling or life threatening complications.7 In osteomyelitis treatment, eradication of the bacterial infection is essential. Acute osteomyelitis is often treated with systemic antibiotic administration, where chronic osteomyelitis treatment often requires surgical debridement in combination with local and systemic administration of broad-spectrum antibiotics like vancomycin, ciprofloxacin, and gentamicin.1 Systemic administration of these antibiotics causes systemic side effects and the effects and concentrations at the infection site are low. Thereby, osteomyelitis compromises the local vascularity, which decreases the effects of oral or parenteral administration.8 A higher delivery of antibiotics can be performed using local administration of antibiotics, which results in a major increase of the concentrations at the infection site. Some antibiotic carriers that can perform this local administration are antibiotic-loaded spacers, PMMA beads, or antibiotic loaded bone graft substitutes like calcium sulphate pellets and collagen fleeces. Besides the antibiotic-loaded bone graft substitutes, there are synthetic bone graft substitutes without antibiotics but which do have antimicrobial capacities, like bioactive glass S53P4.9-10


  1. O. Conterno and M. D. Turchi, “Antibiotics for treating chronic osteomyelitis in adults,” The Cochrane Database of Systematic Reviews, vol. 9, Article IDCD004439, 2013.
  2. D. P. Lewand P. F. A. Waldvogel, “Osteomyelitis,” The Lancet, vol. 364, no. 9431, pp. 369–379, 2004.
  3. Hogan, V. G. Heppert, and A. J. Suda, “Osteomyelitis,” Archives of Orthopaedic and Trauma Surgery, vol. 133, no. 9, pp. 1183–1196, 2013.
  4. C. B. Pollard, J. E. Newman,N. J.Barlow, J. D. Price, andK.M. Willett, “Deep wound infection after proximal femoral fracture: consequences and costs,” The Journal of Hospital Infection, vol. 63, no. 2, pp. 133–139, 2006.
  5. Trampuz and A. F. Widmer, “Infections associated with orthopedic implants,” Current Opinion in Infectious Diseases, vol. 19, no. 4, pp. 349–356, 2006.
  6. F. Widmer, “New developments in diagnosis and treatment of infection in orthopedic implants,” Clinical InfectiousDiseases, vol. 33, supplement 2, pp. S94–S106, 2001.
  7. Parsons and E. Strauss, “Surgical management of chronic osteomyelitis,” The American Journal of Surgery, vol. 188, no. 1, supplement 1, pp. 57–66, 2004.
  8. Geurts, J. J. Chris Arts, and G. H. I. M. Walenkamp, “Bone graft substitutes in active or suspected infection. Contraindicated or not?” Injury, vol. 42, supplement 2, pp. S82–S86, 2011.
  9. C. Corac¸a-Huber, M. Fille, J. Hausdorfer, D. Putzer, andM. Nogler, “Efficacy of antibacterial bioactive glass S53P4 against aureus biofilms grown on titanium discs in vitro,” Journal of Orthopaedic Research, vol. 32, no. 1, pp. 175–177, 2014.
  10. S. Kluin, H. C. van der Mei, H. J. Busscher, and D. Neut, “Biodegradable vs non-biodegradable antibiotic delivery devices in the treatment of osteomyelitis,” Expert Opinion on Drug Delivery, vol. 10, no. 3, pp. 341–351, 2013.