The role of bioactive glass in the management of chronic osteomyelitis: a systematic review of literature and current evidence.

Background: The increase of orthopaedic surgical interventions has given rise to an increased prevalence of chronic osteomyelitis. The principles of management of chronic osteomyelitis are well defined and include a thorough debridement, dead space management followed by an adequate period of appropriate antibiotics. Bioactive glass has garnered interest in recent years as a potential void filler following debridement. In the present systematic review, we explore the role of bioactive glass as a dead space management agent following debridement of chronic osteomyelitis.Methods: A search was made for all the articles pertaining to the role of bioactive glass in chronic osteomyelitis. The keywords used for search in PUBMED/MEDLINE were 'Bioactive glass' and 'chronic osteomyelitis'. A total of nine publications evaluating the outcome of 206 patients were included for evaluation.Results: The overall cure rate was 86% with 24 patients (11.6%) experiencing recurrence, while five patients were lost to follow-up. Out of the total 24 recurrences or persistent infections, 10 were associated with poor post-operative wound healing which progressed to recurrence.Conclusions: Bioactive glass appears to provide an attractive alternative for bone void filling after debridement of chronic osteomyelitis with good long-term outcomes. Potential advantages include a unique mechanism of anti-microbial action rendering it active against multi-drug resistant bacteria, use as a single stage procedure and gradual replacement by bone.