A retrospective cohort study comparing the effects on inflammatory response and clinical outcomes of vancomycin-PMMA versus vancomycin-sulfate calcium in chronic osteomyelitis

Purpose This study aimed to compare the impact on inflammatory response, clinical efficacy, and safety between vancomycin-loaded polymethylmethacrylate (PMMA) and a combination of vancomycin-loaded PMMA with vancomycin sulfate calcium (PMMA-SC) in treating chronic osteomyelitis.Methods A retrospective cohort study involved 244 patients with chronic osteomyelitis treated between January 2017 and December 2024. Patients were divided into PMMA (n = 126) and PMMA-SC (n = 118) groups. Postoperative outcomes, efficacy, inflammatory markers, quality of life, and complications were evaluated.Results The PMMA-SC group demonstrated significantly higher rates of infection control (87.29% vs. 72.22%, p = 0.004) and lower reoperation rates (7.63% vs. 21.43%, p = 0.002) compared to the PMMA group. The PMMA-SC intervention was associated with a more robust attenuation of systemic inflammation, evidenced by significantly greater reductions in neutrophil-to-lymphocyte ratio (NLR), platelet-to-lymphocyte ratio (PLR), systemic immune-inflammation index (SII), erythrocyte sedimentation rate (ESR), C-reactive protein (CRP), and procalcitonin (PCT) (all p < 0.05). Quality of life measures, particularly physical functioning, general health, and vitality, also favored the PMMA-SC group (p < 0.05). The overall complication rate was significantly lower in the PMMA-SC group (8.47% vs. 26.19%, p < 0.001). The multivariate logistic regression analysis demonstrated that PMMA-SC was a significant protective factor for treatment success (p < 0.05).Conclusion The combination of vancomycin sulfate calcium with PMMA was associated with improved outcomes compared to PMMA alone, potentially attributable to its association with enhanced control of infection and a more favorable modulation of the systemic inflammatory and immune response. These findings support its consideration as a promising therapeutic strategy for chronic osteomyelitis.