Antibiotic-loaded collagen sponges in clinical treatment of chronic osteomyelitis: a systematic review

T.A.G. van Vugt (Corresponding author), J.M.B. Walraven, J.A.P. Geurts, J.J.C. Arts

Research output: Contribution to journalReview articleAcademicpeer-review

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Chronic osteomyelitis is caused by bacterial infection of the bone and is a major problem in orthopaedic surgery. Treatment of chronic osteomyelitis requires surgical debridement accompanied by local and systemic administration of antibiotics. A widely established biodegradable local antibiotic carrier is antibiotic-loaded collagen sponges (fleeces). These sponges are commonly used in the treatment of chronic osteomyelitis, but a systematic review of their clinical efficacy and assessment of the quality of evidence have not been conducted, to our knowledge.Methods:This systematic review, performed according to the PRISMA statement, examined the clinical efficacy of and quality of evidence regarding different antibiotic-loaded collagen sponges in the clinical treatment of chronic osteomyelitis. Clinical efficacy was defined as eradication of infection with bone and wound-healing. In addition, the in vivo pharmacokinetics of the various collagen sponges were evaluated. Quality was based on the Level of Evidence, methodological quality, and risks of bias.Results:A total of 813 articles were screened, and 10 were included. Gentamicin-sulfate sponges and gentamicin-sulfate/gentamicin-crobefate sponges were studied. A total of 413 patients were treated, with a success rate of 91%. Reported complications were fistulas, prolonged wound drainage, and wound-healing problems. In vivo pharmacokinetic profiles showed an average local antibiotic concentration that was above the minimum inhibitory concentration for only 5 days. The general quality of the included studies was low to moderate, and there was a moderate to high risk of bias.Conclusions:The evidence quality and Level of Evidence of the included studies were low, and the risk of bias in these studies was high. This makes the evidence regarding these sponges inconclusive, and no clinical decision-making can be based on these studies. Utilization of antibiotic-loaded collagen sponges in the treatment of chronic osteomyelitis should only be carried out with caution; studies with high-level evidence are needed.Level of Evidence:Therapeutic Level IV. See Instructions for Authors for a complete description of levels of evidence.

Original languageEnglish
Pages (from-to)2153-2161
Number of pages9
JournalJournal of Bone and Joint Surgery. American Volume
Issue number24
Publication statusPublished - 19 Dec 2018


  • Absorbable Implants
  • Adult
  • Anti-Bacterial Agents/administration & dosage
  • Chronic Disease
  • Collagen
  • Female
  • Gentamicins/administration & dosage
  • Humans
  • Male
  • Middle Aged
  • Osteomyelitis/drug therapy
  • Research Design
  • Surgical Sponges
  • Treatment Outcome


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