The Use of Antibiotic-Impregnated Cement for Infection or Mechanical Support in Diabetic Foot Osteomyelitis: A Systematic Review and Meta-Analysis.

Abstract

BackgroundDiabetic foot infections are difficult to eradicate and could lead to serious complications such as multiple surgeries, amputation and mortality. Culture-based IV antibiotics and particularly amputation are usually the available options. Only few studies articles reported the use of cement impregnated with antibiotics to fill temporarily or permanently a bone defect, but with no evidence synthesis yet. Therefore, this study aims at assessing the outcomes of the use of antibiotic-impregnated cement for infection or mechanical support in diabetic foot osteomyelitis.MethodsA systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. We searched multiple electronic databases using the terms "osteomyelitis AND cement AND diabetic AND foot." The quality of the included studies was evaluated using the Joanna Briggs Institute Appraisal Tool.ResultsSix studies met the inclusion criteria combining 82 patients with 85 procedures. With a mean follow-up period of 22 ±14.6 months, the meta-analytical results were as follows: (1) the weighted healing rate was 85.2%, (2) 63.6% of cement were kept in place, (3) 8.2% of cement had to be exchanged, (4) 24.4% of placed cement had to be removed, (5) minor amputation following cement placement was 13.4%, and (6) the rate of secondary surgery was 18.7%, with arthrodesis being the most common (94%).ConclusionThere are limited studies available detailing the outcomes of cement use in diabetic foot osteomyelitis. In the case of the difficult-to-heal osteomyelitis of the diabetic foot and whenever a peripheral bone rim could be preserved, filling the void within to deliver local infection control and to assure mechanical resistance for ambulation could be a non-radical limb preserving option.Level of EvidenceLevel IV.