MID-TERM OUTCOMES OF SINGLE-STAGE SURGICAL MANAGEMENT OF CHRONIC OSTEOMYELITIS USING A BIOABSORBABLE GENTAMICIN-LOADED CERAMIC CARRIER

Aim Chronic osteomyelitis continues to present major challenges in orthopedic and trauma surgery. Surgical excision of infected bone creates a defect that must be managed effectively to prevent reinfection. Due to limited penetration of systemic antibiotics into devascularized bone, local antibiotic delivery has gained importance as a therapeutic adjunct. This prospective study evaluates the efficacy of a single-stage surgical protocol using a bioabsorbable calcium sulfate/hydroxyapatite composite loaded with gentamicin. Results are also compared to a previous cohort from the same institution (Niemann et al.). Method Thirty-six patients with chronic osteomyelitis (Cierny-Mader types III and IV) were treated in a single-stage procedure involving radical debridement, deep tissue sampling, local and systemic antibiotic administration, and immediate soft tissue closure. The diagnosis was confirmed through strict clinical and microbiological criteria. The average follow-up period was 3.05 years (range: 2.2–6.4 years). Results Three patients experienced recurrence, corresponding to a 94.2% infection-free rate. All recurrences occurred within the first postoperative year. No significant associations were found between recurrence and physiological classification, infection etiology, pathogen type, or preoperative pseudarthrosis. Gentamicin-resistant pathogens were significantly more common in polymicrobial infections, but resistance did not correlate with increased recurrence. Compared to the prior cohort studied by Niemann et al., the need for revision surgery decreased significantly—from 10 out of 22 patients to 4 out of 36 in the current group—representing a 75% reduction. Conclusion The use of an absorbable, antibiotic-loaded calcium sulfate/hydroxyapatite composite appears to be a safe and effective option for treating chronic osteomyelitis. Complete resorption of the material reduces the risk of foreign body retention after antibiotic delivery. The single-stage surgical approach, in conjunction with local high-dose antibiotic therapy, has shown durable outcomes over midterm follow-up. The improvement in revision rates compared to earlier results may be attributed to enhanced soft tissue management and growing experience with the bio-composite material. Continued research is necessary to evaluate long-term outcomes and to better understand patient-specific prognostic factors.