The surgical management of long bone infections is often challenging. Adequate surgical debridement decreases the bacterial load, removes dead tissues, and gives a chance for the host immune system and antibiotics to arrest infection. Adequate debridement may leave a large bony defect. An appropriate management of the dead space is essential to arrest the disease, and for maintenance of the bone's integrity. The current strategy includes the use of antibiotic-loaded bone cement that can be used to sterilize and temporarily maintain the dead space. The cement are usually removed after 2 to 4 weeks and replaced with a cancellous graft harvested from the hip of the patient. CERAMENT™\| G is a CE-marked resorbable ceramic bone graft substitute composed by calcium sulfate and calcium hydroxyapatite, intended to fill gaps and voids in the skeleton system and to promote bone healing. The antibiotic gentamicin is included in the ceramic to prevent colonization of gentamicin-sensible microorganisms in order to protect bone healing. The aim of this study is to investigate the device absorption and bone in-growth of CERAMENT™\| G in a surgically revised bone infection. In addition, bone healing and infection non-recurrence will be evaluated during 12 months of follow-up. The investigators expect a treatment success of \>90 % and that a similar bone healing will be obtained as with a standard two-stage surgical procedure. In addition, the investigators believe that the use of CERAMENT™\| G will be of advantage for the patient as bone healing will be achieved with a one-stage surgical procedure (in combination with antibiotic therapy), instead of a two-stage procedure, thus decreasing potential surgery-related complications.
Study Type
INTERVENTIONAL
Allocation
NA
Purpose
TREATMENT
Masking
NONE
Enrollment
15
Lausanne University Hospital, Service of Orthopedy and Traumatology
Lausanne, Canton of Vaud, Switzerland
RECRUITINGDegree of device absorption after insertion of the device (during follow-up).
The degree of device absorption will be evaluated by localized CT-scans 3 and 12 months after surgery.
Time frame: 3 and 12 months after surgery.
Advances in bone in-growth after insertion of the device (during follow up).
Bone in-growth will be evaluated by localized CT-scans 3 and 12 months after surgery.
Time frame: 3 and 12 months after surgery.
Bone healing
Bone healing will be evaluated by X-ray 6 weeks, 3 months, 6 months and 12 months after surgery.
Time frame: 6 weeks, 3 months, 6 months and 12 months after surgery.
Infection non-recurrence
Infection non-recurrence will be verified by measuring inflammatory blood parameters and body temperature, and through clinical examination (looking for pain, swelling, warmth and redness) during hospitalization (an expected average of 14 days following the surgery), and 6 weeks, 3 months, 6 months and 12 months after surgery (i.e. at each follow-up visit according to standard clinical praxis).
Time frame: During hospitalisation and 6 weeks, 3 months, 6 months and 12 months after surgery.
Serum gentamicin levels
For evaluation of the gentamicin elution from the ceramic, serum gentamicin levels will be measured 24 h, 48 h and 72 h after surgery (during hospitalisation).
Time frame: 24 h, 48 h and 72 h after surgery.
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