Calcium sulfate in the management of osteomyelitis: A systematic review and meta-analysis of comparative studies

Background: Calcium sulfate (CS) is used extensively as an antibiotic carrier in the treatment of chronic osteomyelitis, largely due to its biodegradable nature. The aim of this systematic review and meta-analysis is to analyze the comprehensive performance of CS in the literature when compared to other biomaterials or treatments for osteomyelitis. We assess the ability of CS to eradicate infection and achieve other key clinical outcomes. Methods: All studies comparing the use of CS to any other surgical technique for the surgical management of osteomyelitis were eligible for analysis. The indication for surgery in each case was chronic osteomyelitis. The minimum dataset required included details regarding infection eradication rates, union rates (in cases of nonunion), all-cause revision surgery and wound leakage. The primary outcome variables of concern were infection eradication and all-cause revision surgery. Secondary outcome variables included union and wound leakage. A random effects meta-analysis was performed. Results: Five studies were deemed eligible for inclusion. The CS group had a significantly higher rate of infection eradication (P=.013) and a significantly lower rate of revision for all causes (P<.001) when compared to the comparative group. In total, the CS group had 30 cases of wound leakage compared to 8 in the comparative group (P=.064). Conclusion: CS demonstrates superior rates of infection eradication and all-cause revision when compared with alternative treatment methods for chronic osteomyelitis. While the current study reports on differing but nonsignificant rates of wound leakage between CS and other treatments, future studies are required to accurately investigate this clinically important complication.