J Korean Orthop Assoc.  2024 Aug;59(4):301-307. 10.4055/jkoa.2024.59.4.301 .

Utility of Antibiotic-Loaded Dicalcium Phosphate Dehydrate/ β-Tricalcium Phosphate in the Surgical Treatment of Diabetic Foot Osteomyelitis

• Kim Th
• Choi Bh
• Kim Jk

• KMID: 2558598
• DOI: http://doi.org/10.4055/jkoa.2024.59.4.301

Abstract

Purpose
This retrospective study evaluated the effectiveness and healing outcomes of antibiotic-loaded dicalcium phosphate dehydrate/ β-tricalcium phosphate (β-TCP/DCPD) compared to antibiotic-loaded polymethylmethacrylate (PMMA) cement in the treatment of diabetic foot osteomyelitis (DFO).
Materials and Methods
The study examined 31 patients diagnosed with DFO from 2019 to 2021. The participants underwent surgical debridement accompanied by systemic antibiotic therapy, applying either antibiotic-loaded PMMA beads (group P, n=20) or antibiotic-loaded β-TCP/DCPD beads (group N, n=11). The assessment criteria included the Cierny-Mader and C-M Host classification for osteomyelitis, Wagner Diabetic Foot Ulcer classification, and the parameters for nonvascular surgical treatment.
Results
The healing rates were 95% and 100% in groups P and N, respectively (p=0.543). The median healing time was 18 and 19 weeks for groups P and N, respectively (p=0.094). Amputation was necessary for one patient (5%) in group P. The DFO recurrence rates were 10% and 9% in groups P and N, respectively (p=0.534). The median hospital stay was 34 and 31 days for groups P and N, respectively (p=0.634). In particular, postoperative antibiotic bead leakage occurred in 5% and 45% of groups P and N, respectively (p=0.006).
Conclusion
β-TCP/DCPD, as a drug delivery system, is an effective adjunct for treating deep diabetic foot infections. Nevertheless, the higher incidence of surgical site antibiotic bead leakage with β-TCP/DCPD necessitates careful consideration of its application.

Keyword

foot; osteomyelitis; diabetic foot; anti-bacterial agents