Multiple difficulties occur during treatment of different orthopedic infections such as biofilm formation, osteonecrosis, destruction of bone matrix, and compromised soft tissues and vascularization. Biomaterials can be used to treat the infection and to solve the different treatment difficulties. These biomaterials can elicit local antibacterial therapy, which is necessary for optimal treatment of orthopedic infections. Furthermore, they can also be used as a bone defect filler after debridement surgery. Different types of biomaterials are developed: antibiotic-loaded collagen fleeces and ceramic or composite calcium-based bone graft substitutes as calcium sulfates, calcium phosphates, and hydroxyapatite. Another biomaterial used in treatment of these infections is bioactive glass. In this chapter, the properties of different biomaterials regarding treatment of infection are elucidated and the clinical results of these biomaterials in treatment of chronic osteomyelitis are discussed.

Biomaterials in treatment of orthopedic infections

Metachromatic leukodystrophy (MLD) is a fatal inherited lysosomal storage disease that can be detected through newborn bloodspot screening. The feasibility of the screening assay and the clinical rationale for screening for MLD have been previously demonstrated, so the aim of this study is to determine whether the addition of screening for MLD to the routine newborn screening program in the UK is a cost-effective use of National Health Service (NHS) resources. A health economic analysis from the perspective of the NHS and Personal Social Services was developed based on a decision-tree framework for each MLD subtype using long-term outcomes derived from a previously presented partitioned survival and Markov economic model. Modelling inputs for parameters related to epidemiology, test characteristics, screening and treatment costs were based on data from three major UK specialist MLD hospitals, structured expert opinion and published literature. Lifetime costs and quality-adjusted life years (QALYs) were discounted at 1.5% to account for time preference. Uncertainty associated with the parameter inputs was explored using sensitivity analyses. This health economic analysis demonstrates that newborn screening for MLD is a cost-effective use of NHS resources using a willingness-to-pay threshold appropriate to the severity of the disease; and supports the inclusion of MLD into the routine newborn screening programme in the UK. 

Exploring the Cost-Effectiveness of Newborn Screening for Metachromatic Leukodystrophy (MLD) in the UK

Fracture-related infection (FRI) remains a challenging complication that imposes a heavy burden on orthopaedic trauma patients. The surgical management eradicates the local infectious focus and if necessary facilitates bone healing. Treatment success is associated with debridement of all dead and poorly vascularized tissue. However, debridement is often associated with the formation of a dead space, which provides an ideal environment for bacteria and is a potential site for recurrent infection. Dead space management is therefore of critical importance. For this reason, the use of locally delivered antimicrobials has gained attention not only for local antimicrobial activity but also for dead space management. Local antimicrobial therapy has been widely studied in periprosthetic joint infection, without addressing the specific problems of FRI. Furthermore, the literature presents a wide array of methods and guidelines with respect to the use of local antimicrobials. The present review describes the scientific evidence related to dead space management with a focus on the currently available local antimicrobial strategies in the management of FRI. LEVEL OF EVIDENCE:: Therapeutic Level V. See Instructions for Authors for a complete description of levels of evidence.

/pdf/evidence-based-recommendations-for-local-antimicrobial-22j64t2el2.pdf

Evidence-Based Recommendations for Local Antimicrobial Strategies and Dead Space Management in Fracture-Related Infection.

[Use of a collagen-gentamicin compound in open spongiosaplasty in chronic post-traumatic osteomyelitis].

EE45 The Societal Costs of Metachromatic Leukodystrophy (MLD) in the Netherlands

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[Use of a collagen-gentamicin compound in open spongiosaplasty in chronic post-traumatic osteomyelitis].

EE45 The Societal Costs of Metachromatic Leukodystrophy (MLD) in the Netherlands