Efficacy of an Antibiotic Loaded Ceramic-Based Bone Graft Substitute for the Treatment of Infected Non-Unions

Biomedicines, 2022 · DOI: 10.3390/biomedicines10102513 · Published: October 8, 2022

Simple Explanation

The study investigates a bone graft substitute called HACaS+G (Cerament G), which contains calcium sulphate-hydroxyapatite loaded with gentamicin. This material aims to promote bone growth and fight infection. The researchers used a rat model with both infected and non-infected non-unions (fractures that don't heal) to see how well HACaS+G worked. The goal was to assess its ability to stimulate bone formation and combat infection. The results showed that while HACaS+G could stimulate bone formation, it didn't provide additional benefits in infected non-unions regarding bone growth or mechanical stability, especially when there were significant bone defects.

Study Duration

8 weeks after the second surgery

Participants

Sixty-five female, 3-month-old Sprague-Dawley rats

Evidence Level

Animal Model

Key Findings

1
HACaS+G demonstrated osteoinductive properties, stimulating bone formation in both infected and non-infected conditions.
2
Under infected conditions, HACaS+G did not enhance osteoconduction or mechanical bone stability, particularly in cases with segmental bone defects.
3
Microbiological analysis revealed that HACaS+G had only a prophylactic effect against infections, without achieving complete eradication of existing infections.

Research Summary

This study evaluates the efficacy of an antibiotic-loaded ceramic-based bone graft substitute (HACaS+G) for treating infected non-unions in a rat model. The results indicate that HACaS+G is osteoinductive but does not provide added benefits in infected non-unions regarding osteoconduction and mechanical stability. The study suggests that while HACaS+G can stimulate bone formation, it may not be sufficient for treating infected non-unions with significant bone defects.

Practical Implications

Limited Use in Infected Non-Unions

Cerament G may not be the best choice for treating infected non-unions with segmental bone defects due to its limited effect on osteoconduction and mechanical stability.

Potential Prophylactic Use

Cerament G could be used as a prophylactic measure against infections in bone grafts.

Further Research Needed

Further studies are necessary to explore combinations of bone substitutes with allogeneic or autologous bone grafting, or with osteoinductive pharmaceuticals, to enhance bone healing in infected non-unions.

Study Limitations

1
The study did not systematically administer antibiotics, which is a necessary component in treating infected non-unions.
2
Microbiological swabs were used for testing, which are inferior to tissue sampling, sonication, or PCR.
3
The short observation time may not have allowed the bone substitute to develop its full osteoconductive potential.

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