BIOGLASS for orthopaedics

The physical properties of bioglass allow us to fight bone infections in orthopaedic surgical interventions: An example at the Galeazzi Othopaedic Institute in Milan, Italy

Chairman of the European Bone and Joint Infection Society Carlo L. Romanò, the director of the project to study bioglass in the surgical treatment of bone deficiencies in orthopaedics (BonAlive)

Established materials in the maxillo-facial surgery field are finding application in orthopaedic surgery, thanks to studies highlighting their significant antibacterial properties. We look at how, at the Galeazzi Orthopaedic Institute, an Institute for Research and Treatment (IRCCS) facility, the physical properties of bioglass highlight this material’s potential for fighting bone infections in orthopaedic surgery.

Bone infections

There are many conditions in orthopaedic surgery that lead to critical situations of bone infection. These necessitate recourse to specific solutions which are traditionally based on intensive use of antibiotics. Bone infections are typically associated with severe bone loss (so-called bone deficiencies), which may be of pathological or traumatic origin. These complications represent one of the most complex, most difficult to treat types of pathologies in orthopaedics.

This is one of the primary causes for failure of prosthetic implants and surgical repairs of traumas that involve the skeleton and leads to bone loss and subsequent difficulties in reconstructing the damaged section. Among the problems that each year affect thousands of patients in Italy who suffer this type of infection, whether resulting from wounds, traumas, or surgical interventions, bone loss plays a significant part and certainly one of the most serious.

Bone deficiency, resulting from both the direct action of bacteria on the bone and the inflammatory state that forms locally, requires treatment that includes special surgical techniques, recourse to synthetic prostheses, an eventual bone graft, or use of bone substitutes impregnated with antibiotics.

All of these techniques require the addition of selected local antibiotics, whose efficacy is sometimes limited by the concomitant increase in bacterial resistance.

Premises for using bioglass

Bone infections: a serious, difficult-to-treat condition that often requires multiple surgical interventions and prolonged antibiotic treatment (BonAlive)

Although bone grafts are established surgical practice, they represent a series of problems. Harvesting of autograft bone (i.e., bone from the patients themselves) may lead to increased duration and complication of the overall procedure, and the use of allograft bone (material from a cadaver or living donor) may lead to the risk of transmitting viral diseases, generates greater costs, and has limited availability. An alternative to bone grafts is the use of ‘bone substitutes’, which are generally calcium-based compounds such as hydroxyapatite. They are used for filling bone deficiencies for their ability to become integrated with the existing bone, compacting its structure.

Bone deficiency after the direct action of bacteria on the bone and the inflammatory state that develops locally in the case of osteomyelitis – a treatment is needed that involves special surgical techniques, synthetic prostheses, an eventual bone graft, or an antibiotic-impregnated bone substitute

The advantages of this solution, beginning with the immediate and endless availability of the material, are offset by a few disadvantages, including greater integration time, arising from the material being foreign to the organism.

Even in conjunction with antibiotics, the bone substitute, which – in contrast to allograft – by its very nature cannot be a carrier of disease, does not exclude the possibility of local inflammations and several weeks of serous discharge. Even the choice of a targeted antibiotic may be insufficient, on account of bacterial resistance and lack of bacterial isolation.

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