A systematic review on bioactive glass as a treatment for extremity osteomyelitis and infected non-union
File(s)
Published version
Author(s)
Claireaux, Harry
Smith, Helen
Edwards, Andrew
Jones, Julian
Ramasamy, arul
Type
Journal Article
Abstract
Aims
Osteomyelitis and infected nonunion cause devastating morbidity and are difficult to treat. Antimicrobial resistance further complicates musculoskeletal infection and is a significant global problem, including in low- and middle-income countries. Extensively drug-resistant bacteria and high rates of musculoskeletal infection have been identified during the Russian-Ukrainian war. Biomaterials with antimicrobial properties unrelated to antibiotics represent a potential solution. Bioactive glass, for example, has shown promise as a bone void filler. It binds to bone, stimulates bone formation, causes no harmful immune response, and has antimicrobial properties. This systematic review appraises the evidence for bioactive glass as a treatment for osteomyelitis and infected nonunion.
Methods
A comprehensive search of MEDLINE and EMBASE was performed with research librarian guidance. Articles were screened and assessed for risk of bias by two blinded authors. No date limitations were used. Methodology was guided by the Cochrane Handbook and the PRISMA statement. Data were compiled and narratively synthesized.
Results
We included 24 observational studies on 957 patients. Reported outcomes were heterogeneous, with patient-reported outcome measures available in only one study. Most studies were small and at considerable risk of bias. Studies supported bioactive glass use with high rates of bone healing and infection resolution. Comparative studies found non-inferiority with established treatments such as antibiotic-containing calcium sulphate and polymethylmethacrylate cement spacers. Few significant bioactive glass-related complications were reported.
Conclusion
This review demonstrates the potential of bioactive glass as a treatment for osteomyelitis and infected nonunion. Widespread uptake over established treatments is likely to require further supporting evidence, such as high-quality randomized controlled trials, to understand the role of biomaterials in treating these challenging conditions. Future work should examine 3D-printed bioactive glass hybrids, which may have biomechanical advantages for large bone defects.
Osteomyelitis and infected nonunion cause devastating morbidity and are difficult to treat. Antimicrobial resistance further complicates musculoskeletal infection and is a significant global problem, including in low- and middle-income countries. Extensively drug-resistant bacteria and high rates of musculoskeletal infection have been identified during the Russian-Ukrainian war. Biomaterials with antimicrobial properties unrelated to antibiotics represent a potential solution. Bioactive glass, for example, has shown promise as a bone void filler. It binds to bone, stimulates bone formation, causes no harmful immune response, and has antimicrobial properties. This systematic review appraises the evidence for bioactive glass as a treatment for osteomyelitis and infected nonunion.
Methods
A comprehensive search of MEDLINE and EMBASE was performed with research librarian guidance. Articles were screened and assessed for risk of bias by two blinded authors. No date limitations were used. Methodology was guided by the Cochrane Handbook and the PRISMA statement. Data were compiled and narratively synthesized.
Results
We included 24 observational studies on 957 patients. Reported outcomes were heterogeneous, with patient-reported outcome measures available in only one study. Most studies were small and at considerable risk of bias. Studies supported bioactive glass use with high rates of bone healing and infection resolution. Comparative studies found non-inferiority with established treatments such as antibiotic-containing calcium sulphate and polymethylmethacrylate cement spacers. Few significant bioactive glass-related complications were reported.
Conclusion
This review demonstrates the potential of bioactive glass as a treatment for osteomyelitis and infected nonunion. Widespread uptake over established treatments is likely to require further supporting evidence, such as high-quality randomized controlled trials, to understand the role of biomaterials in treating these challenging conditions. Future work should examine 3D-printed bioactive glass hybrids, which may have biomechanical advantages for large bone defects.
Date Issued
2025-10-13
Date Acceptance
2025-06-20
Citation
Bone & Joint Open, 2025, 6 (10), pp.1248-1259
ISSN
2633-1462
Publisher
The British Editorial Society of Bone & Joint Surgery
Start Page
1248
End Page
1259
Journal / Book Title
Bone & Joint Open
Volume
6
Issue
10
Copyright Statement
© 2025 Claireaux et al. This article is distributed under the terms of the Creative Commons Attributions (CC BY 4.0) licence (https:// creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original author and source are credited.
License URL
Identifier
10.1302/2633-1462
Publication Status
Published