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Chronic osteomyelitis treatment with PerOssal®: a literature review


Chronic osteomyelitis is an inflammatory process in the bone followed by bone destruction caused by microorganism infection. The annual incidence of osteomyelitis is approximately 21.8 cases per 100,000 person-years in the general population. Implanting antibiotic-loaded carriers directly at the site of infection becomes a promising treatment approach. PerOssal® is an osteoconductive synthetic bone substitute for restoring and filling bone defects. PerOssal® pellets contain 51.1% nanocrystalline hydroxyapatite and 48.5% calcium sulfate. It has a role as bone material to fill bone defects caused by dead bone in chronic osteomyelitis. The porosity of PerOssal® allows a high initial antibiotic release, then decreases to ensure a local concentration of the antibiotic. PerOssal® did not show any in vitro cytotoxicity and fatal adverse event as bone material. PerOssal® is a promising antibiotic-loaded carrier for the management of chronic osteomyelitis. It demonstrates good biocompatibility with initial high antibiotic release without in vitro cytotoxicity and fatal adverse event.


  1. Kremers HM, Nwojo ME, Ransom JE, Wood-Wentz CM, Melton LJ 3rd, Huddleston PM 3rd. Trends in the epidemiology of osteomyelitis: a population-based study, 1969 to 2009. J Bone Joint Surg Am. 2015;97(10):837-845.
  2. Ma X, Han S, Ma J, Chen X, Bai W, Yan W, et al. Epidemiology, microbiology and therapeutic consequences of chronic osteomyelitis in northern China: A retrospective analysis of 255 Patients. Sci Rep. 2018;8(1):14895.
  3. Nugraha A, Rasyid HN, Sukandar H. Profile of Osteomyelitis Patients Visiting the Orthopedic Clinic of Dr. Hasan Sadikin General Hospital, Indonesia, in 2017–2018. Althea Medical Journal. 2021;8(1):43-49.
  4. Dym H, Zeidan J. Microbiology of Acute and Chronic Osteomyelitis and Antibiotic Treatment. Dent Clin North Am. 2017;61(2):271-282.
  5. Ferguson J, Diefenbeck M, McNally M. Ceramic Biocomposites as Biodegradable Antibiotic Carriers in the Treatment of Bone Infections. J Bone Jt Infect. 2017;2(1):38-51.
  6. Fernandez de Grado G, Keller L, Idoux-Gillet Y, Wagner Q, Musset AM, Benkirane-Jessel N, et al. Bone substitutes: a review of their characteristics, clinical use, and perspectives for large bone defects management. J Tissue Eng. 2018;9:2041731418776819.
  7. Rauschmann MA, Wichelhaus TA, Stirnal V, Dingeldein E, Zichner L, Schnettler R, et al. Nanocrystalline hydroxyapatite and calcium sulphate as biodegradable composite carrier material for local delivery of antibiotics in bone infections. Biomaterials. 2005;26(15):2677-84.
  8. von Stechow D, Rauschmann MA. Effectiveness of combination use of antibiotic-loaded PerOssal with spinal surgery in patients with spondylodiscitis. Eur Surg Res. 2009;43(3):298-305.
  9. Fantoni M, Taccari F, Giovannenze F. Systemic antibiotic treatment of chronic osteomyelitis in adults. Eur Rev Med Pharmacol Sci. 2019;23(2 Suppl):258-270.
  10. Anggayanti NA, Sjamsudin E, Sylvyana M, Rizki KA. The management of osteomyelitis at mandible due to neglected fracture: A case report from Hasan Sadikin Hospital, Bandung-Indonesia. Bali Medical Journal. 2018;7(3):556-559.
  11. Rawung R, Moningkey C. Osteomyelitis: A Literature Review. Jurnal Biomedik (JBM). 2019;11(2):69-79.
  12. Maffulli N, Papalia R, Zampogna B, Torre G, Albo E, Denaro V. The management of osteomyelitis in the adult. Surgeon. 2016;14(6):345-360.
  13. Dorati R, DeTrizio A, Modena T, Conti B, Benazzo F, Gastaldi G, et al. Biodegradable Scaffolds for Bone Regeneration Combined with Drug-Delivery Systems in Osteomyelitis Therapy. Pharmaceuticals (Basel). 2017;10(4):96.
  14. Dincel YM. Bone Graft Types. IntechOpen. 2018;3:27–39.
  15. Kumar C Y, K B N, Menon J, Patro DK, B H B. Calcium sulfate as bone graft substitute in the treatment of osseous bone defects, a prospective study. J Clin Diagn Res. 2013;7(12):2926-2928.
  16. Ardhiyanto HB. Peran hidroksiapatit sebagai material. Stogmatognatic. 2012;9(1):16-18.
  17. Pokhrel S. Hydroxyapatite: Preparation, Properties and Its Biomedical Applications. Adv Chem Eng Sci. 2018;8(4):225-240.
  18. Bayani M, Torabi S, Shahnaz A, Pourali M. Main properties of nanocrystalline hydroxyapatite as a bone graft material in treatment of periodontal defects. A review of literature. Biotechnol Biotechnol Equip. 2017;31(2):215-220.
  19. Visani J, Staals EL, Donati D. Treatment of chronic osteomyelitis with antibiotic-loaded bone void filler systems: an experience with hydroxyapatites calcium-sulfate biomaterials. Acta Orthop Belg. 2018;84(1):25-29.
  20. Gogia JS, Meehan JP, Di Cesare PE, Jamali AA. Local antibiotic therapy in osteomyelitis. Semin Plast Surg. 2009;23(2):100-7.
  21. Geurts JAP, van Vugt TAG, Arts JJC. Use of contemporary biomaterials in chronic osteomyelitis treatment: Clinical lessons learned and literature review. J Orthop Res. 2021;39(2):258-264.

How to Cite

Mardana, I. K. R. P., Kesuma, A. A. N. R., Saputra, I. K. A. K., & Laksana, I. K. M. (2022). Chronic osteomyelitis treatment with PerOssal®: a literature review. Intisari Sains Medis, 13(1), 319–322.




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I Kadek Riyandi Pranadiva Mardana
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Anak Agung Ngurah Ronny Kesuma
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I Komang Agus Krisna Saputra
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I Komang Mahendra Laksana
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