Current orthopaedic surgeon use of bioresorbable beads for antibiotic delivery

Stuart D. Miller, Bryan Bean, Lew C. Schon

Research output: Chapter in Book/Report/Conference proceedingConference contribution

Abstract

Current orthopedic foot and ankle surgery involves frequent patient issues of soft-tissue infection and osteomyelitis, the treatment of which often involves both systemic and local antibiotics. Treatment options have advanced over the past 25 years from antibiotics in polymethylmethacrylate beads to antibiotics in resorbable carriers such as calcium sulfate and calcium phosphate. Current preference is the use of vancomycin and gentamycin mixed in with a calcium sulfate powder that crystalizes in a standard fashion to beads. The newer generation of antibiotic beads offers reliable elution of antibiotics and slow resorption of carriers. Prior beads, mixed with a different calcium sulfate, produced beads that delivered antibiotics but with significant drainage for weeks after implantation. While some of the information about these bead formulations is public, standards for bead composition, crystalline structure, elution, and resorption have yet to be developed. The various antibiotics may have profound effects on the beads as well. Current use of antibiotic calcium sulfate beads includes intraoperative implantation into bone or soft-tissue voids, or both. The time frame for observation and repeat implantation remains a clinical decision. The beads have also enjoyed use in our offices for placement in postoperative wound infections or minor wound dehiscence. This “off-label” use of antibiotic beads has significantly reduced the need for reoperation and has treated many minor infections in a major orthopedic foot and ankle training program. Such treatments are difficult subjects for academic papers given the various clinical presentations, but certainly a better understanding of the physical properties of the antibiotic beads would be helpful in guiding clinical practice. In addition, as other companies produce new formulations, physicians need a method of comparison.

Original languageEnglish (US)
Title of host publicationAntimicrobial Combination Devices
EditorsKenneth L. Urish, William M. Mihalko
PublisherASTM International
Pages75-88
Number of pages14
ISBN (Electronic)9780803177062
DOIs
StatePublished - 2020
Event2019 Symposium on Antimicrobial Combination Devices - Houston, United States
Duration: Nov 5 2019Nov 5 2019

Publication series

NameASTM Special Technical Publication
VolumeSTP 1630
ISSN (Print)0066-0558

Conference

Conference2019 Symposium on Antimicrobial Combination Devices
CountryUnited States
CityHouston
Period11/5/1911/5/19

Keywords

  • Antibiotic bead
  • Calcium sulfate
  • Osteomyelitis

ASJC Scopus subject areas

  • Materials Science(all)

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