Cerament® Bone Void Filler in Vascular Patients With Calcaneal Osteomyelitis: Outcomes From a Prospective Case Series

ObjectiveCerament® bone void filler combined with an antimicrobial agent has been shown to be effective in both reducing post operative infections and the treatment of osteomyelitis in orthopaedic surgery. Patients under the care of vascular surgery have significant co-morbidities with a mixture of lower limb arterial insufficiency and poor wound healing secondary to diabetes. Conventional management for heel ulcers relies on the improvement of distal blood flow, debridement of infected tissue and antibiotic therapy, though many patients fail to improve with these measures. The purpose of this case series was to report the outcomes of Cerament® G and V in vascular patients who have not responded to conventional treatments.MethodsConsecutive patients with heel ulceration and osteomyelitis secondary to peripheral vascular disease and/or diabetic complications were included and followed up for a median duration of 8 months. Patients underwent a single application of Cerament® G or V to the calcaneal body and debridement. Outcomes included improvement in ulceration, repeat surgical intervention, amputation rate, further anti-microbial therapy, and impact on mobility.ResultsAfter exclusion of two patients due to death and major limb amputation during index admission, 20 patients were included in the study with a median age of 76 years (range 49-87), of which 70% were males. 14 patients (70%) had improvement in their ulcer appearance at follow up. 4 patients (20%) required repeat Cerament® and 4 patients (20%) required lower limb amputation. 3 (15.0%) patients required further course of anti-microbial treatment. Mobility was improved in 5 patients (25%, P < 0.01).ConclusionIn this case series of high-risk vascular patients, single-stage application of Cerament® for heel ulcers with calcaneal osteomyelitis was associated with improvement of ulcer healing, limb preservation, and improved mobility. Further randomized, controlled studies are needed to confirm efficacy in comparison to standard therapy.