Osteoplastic properties of an antibiotic-impregnated polymeric bone substitute material in chronic osteomyelitis of the calcaneus and tibia
Year: 2026
Type: article
Abstract: Background. Reconstruction of post-osteomyelitis defects of the long bones and foot remains a complex clinical and surgical challenge for which no universal approach has been established. The aim of the study — to evaluate the osteoplastic properties of an antibiotic-impregnated polymeric bone substitute material in the treatment of chronic osteomyelitis of the calcaneus and tibia. Methods. Surgical material from 6 patients (5 males, 1 female, age 57.0 [32.5; 62.3] years) with chronic osteomyelitis of the leg and foot was studied. All patients underwent sequesternecrectomy with subsequent filling of the cavitary defect with a polymeric bone substitute material impregnated with antibiotics. When relapse of chronic osteomyelitis occurred, repeated surgical treatment was performed with tissue sampling for morphological examination, which was carried out on paraffin sections. Results. Following reconstruction of osteomyelitic cavities in the tibia with the polymeric bone substitute, the median bone tissue proportion at 7.8 and 16.5 months after surgery was 15.45% and 28.64%, respectively. In cases with osteomyelitic cavities of the tibia, the relapse-free period exceeded 1.5 years. Following reconstruction of osteomyelitic cavities in the calcaneus with the partially bioresorbable material, approximately half of its volume consisted of blood cells, granulation tissue, and connective tissue at 3.5-6.2 months. The maximum median bone tissue proportion at 6.2 months post-implantation was 5.45%. At 9.9 months post-implantation, granulation tissue and dense fibrous connective tissue predominated in the material cavities within the calcaneus, while newly formed bone trabeculae were encountered only occasionally. With longer implantation periods, the median proportion of the polymer decreased in both the calcaneus and the tibia. Histological signs of an inflammatory process were noted in 83% of cases. A diffuse lymphohistiocytic infiltrate, focal accumulations of neutrophils, and multinucleated giant cells of the foreign body type were observed. Conclusions. The non-overlapping ranges of bone tissue proportion within the antibiotic-impregnated polymeric bone substitute material used to fill osteomyelitic defects in the tibia and calcaneus point to substantial differences in reparative bone formation and suggest that osteoplastic properties are more pronounced in the tibia. The inflammatory infiltrate was predominantly composed of lymphocytes, macrophages, plasma cells, and focal accumulations of neutrophils. In all cases, slow degradation of the polymer was observed, accompanied by a pronounced giant cell reaction.
Language: English
Subfield: Surgery
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7203643154