Antibiotic-Loaded Hydroxyapatite Ceramic in the Management of Diabetic Foot Osteomyelitis: An Investigation of Factors That Determine Patient Outcomes

Background: Diabetic foot osteomyelitis is a complex condition to manage, with substantial risk of treatment failure, which could necessitate major amputations. Surgical debridement and prolonged systemic antibiotic therapy have been the mainstay of treatment, but recurrence rates remain high. The use of adjuvant local antibiotic therapy has been proposed as a potential adjunct to improve outcomes. Methods: This retrospective study involved 113 patients with diabetic foot osteomyelitis, who underwent debridement and application of antibiotic-loaded hydroxyapatite ceramic from the year 2018 to 2023. Clinical outcomes of interest were eradication of infection, ulcer healing, recurrence of infection, prevention of major amputation and mortality rate. Patient-associated factors were identified and analysed. Results: Eradication of infection was achieved in 96%, healing of ulcer in 93% and limb salvage in 95% of patients. The mortality rate at 1 year was 5.4%. Peripheral arterial disease, HbA1c and CRP levels were statistically significant in affecting treatment outcomes. Other factors had no impact on the treatment success. Conclusions: This is the largest single-centre study involving Cerament G and V in the management of diabetic foot osteomyelitis and the first investigating the specific factors associated with outcome goals. The use of these antibiotic-loaded carriers demonstrated excellent eradication of infection, healing of ulcer and limb salvage and prevention of recurrence of infection.