Prospective comparative analysis of efficacy of local debridement with or without vancomycin impregnated calcium sulphate in chronic osteomyelitis.

The primary objective of this study was to compare the efficacy of use of Vancomycin impregnated bioabsorbable calcium sulphate (VCS) pellets along with surgical debridement to control group without the use of calcium sulphate for chronic osteomyelitis. The secondary objective was comparing the results in different subtypes of chronic osteomyelitis. Methods: 50 consecutive patients were enrolled in VCS group and control group based on used whether VCS was used in treatment in addition to surgical debridement or not. Patients were classified using Cerny Mader Classification and were serially followed up to compare efficacy of eradication of infection and complications between the groups. Results: Patients were followed for a minimum of 24 months postoperatively (range, 24-63 months; mean 32.2 ± 4.2months). 88% (44/50) of patients in VCS group achieved eradication of infection when compared to 64% (32/50) in control group at 2-year follow-up period (p < 0.001). Three out of six patient with recurrence in VCS group and 11 out 18 patients in control group achieved eradication after second stage surgery using same protocol using VCS. Among 10 with persistent infection, 5 among these were those with diffuse osteomyelitis and 5 were those with medullary osteomyelitis. In VCS group, 18/50 patients had persistent serous drainage from the wound for up to 4 weeks which was self-limiting. Conclusion: Local debridement combined with antibiotic impregnated calcium sulphate as a single-stage treatment is effective in treating chronic localized osteomyelitis when compared to debridement alone. However, its use alone in diffuse osteomyelitis may be less effective.