The role of bioactive glass in the management of chronic osteomyelitis: a systematic review of literature and current evidence.

Background

The increase of orthopaedic surgical interventions has given rise to an increased prevalence of chronic osteomyelitis. The principles of management of chronic osteomyelitis are well defined and include a thorough debridement, dead space management followed by an adequate period of appropriate antibiotics. Bioactive glass has garnered interest in recent years as a potential void filler following debridement. In the present systematic review, we explore the role of bioactive glass as a dead space management agent following debridement of chronic osteomyelitis.

Methods

A search was made for all the articles pertaining to the role of bioactive glass in chronic osteomyelitis. The keywords used for search in PUBMED/MEDLINE were 'Bioactive glass' and 'chronic osteomyelitis'. A total of nine publications evaluating the outcome of 206 patients were included for evaluation.

Results

The overall cure rate was 86% with 24 patients (11.6%) experiencing recurrence, while five patients were lost to follow-up. Out of the total 24 recurrences or persistent infections, 10 were associated with poor post-operative wound healing which progressed to recurrence.

Conclusions

Bioactive glass appears to provide an attractive alternative for bone void filling after debridement of chronic osteomyelitis with good long-term outcomes. Potential advantages include a unique mechanism of anti-microbial action rendering it active against multi-drug resistant bacteria, use as a single stage procedure and gradual replacement by bone.