the Need for Antibiotic Bone Cement Removal in Osteomyelitis

The issue of antibiotic-impregnated bone cement in osteomyelitis?

Hello Doctor, I had a car accident in my youth that required surgery, which later led to the development of osteomyelitis.
After multiple surgeries for debridement, it has recurred.
In May of this year, I underwent surgery for osteomyelitis again, and the doctor placed antibiotic-impregnated bone cement, stating that once my condition stabilizes, I would need another surgery to remove the antibiotic bone cement, as it is considered a foreign body and can be detrimental to the bone.
I would like to know if it is absolutely necessary to remove it.
What are the potential long-term effects or complications if it is left in place? Thank you!

Belinda, 50~59 year old female. Ask Date: 2022/06/28

Dr. Chen Bochen reply Orthopedics

Hello, it is not absolutely necessary to remove it, but if the infection is well controlled, removal can reduce the chance of reinfection (by minimizing foreign material).
If there is a recurrent purulent infection, it should also be removed.

Reply Date: 2022/06/28

More Info

The use of antibiotic-loaded bone cement (ALBC) in the treatment of osteomyelitis is a common practice aimed at delivering localized antibiotics directly to the site of infection while providing structural support. However, the necessity for its removal after the infection has been controlled is an important consideration in orthopedic practice.

Why Remove Antibiotic Bone Cement?
1. Foreign Body Reaction: Although antibiotic bone cement serves a therapeutic purpose, it is still considered a foreign body. The presence of foreign materials in the body can provoke a chronic inflammatory response, which may lead to complications such as persistent pain, swelling, or even recurrent infections.

2. Bone Healing: The long-term presence of bone cement can interfere with the natural healing processes of bone. It may impede the integration of new bone tissue and the remodeling process, potentially leading to impaired bone regeneration or delayed healing.

3. Infection Risk: While the antibiotic component of the cement helps to manage infection initially, the cement itself can become a nidus for future infections. Bacteria can colonize the surface of the cement, leading to a risk of reinfection, especially if the cement remains in place for an extended period.

4. Mechanical Stability: Over time, the mechanical properties of the cement may degrade, which can affect the stability of the surrounding bone structure. This is particularly critical in load-bearing areas where the integrity of the bone is essential for function.

Potential Consequences of Long-Term Placement
If the antibiotic bone cement is not removed, several complications may arise:
- Chronic Pain: Patients may experience ongoing discomfort or pain due to the foreign body reaction.

- Infection Recurrence: There is a risk of reinfection, which may necessitate further surgical interventions.

- Impaired Bone Healing: The presence of the cement may hinder the natural healing processes, leading to non-union or malunion of fractures.

- Mechanical Failure: In cases where the cement is used to stabilize fractures or defects, long-term presence may lead to mechanical failure, necessitating additional surgeries.

Conclusion
In summary, while antibiotic bone cement plays a crucial role in the management of osteomyelitis, its removal is generally recommended once the infection is under control. This is to prevent potential complications associated with its long-term presence, including chronic inflammation, impaired healing, and increased risk of reinfection. It is essential to follow your orthopedic surgeon's advice regarding the timing and necessity of the removal procedure, as they will consider your specific clinical situation, the extent of your osteomyelitis, and your overall health status. Always discuss any concerns or questions with your healthcare provider to ensure you receive the best possible care tailored to your needs.

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