Evaluation of Antibiotic-Loaded Bone Cement in Treatment of Infected Diabetic Foot: Systematic Review and Meta-Analysis

Background: Diabetic foot ulcer (DFU) is a common and complex complication in patients with diabetes mellitus. The study of antibiotic-loaded bone cement for the treatment of infected diabetic foot is limited. We aimed to assess the efficacy of antibiotic-loaded bone cement for the treatment of infected diabetic foot.

Methods: The MEDLINE, Embase, BIOSIS, the Cochrane Central Register of Controlled Trials (CENTRAL), and Web of Knowledge databases were systematically searched up to May 2023 with no language restrictions. We assessed eligible studies for the efficacy of antibiotic-loaded bone cement for the treatment of infected diabetic foot. The standard mean differences (SMDs) or the risk ratios (RRs) were calculated for continuous or dichotomous data, respectively. Data were analysed using the Cochrane Collaboration's RevMan 5.0 software.

Results: Nine articles with 565 patients were analysed in our meta-analysis. The wound healing time in ABC group was significantly shorter than that in the control group (SMD = -1.64, 95% CI -2.27 to -1.02 p < 0.00001, I² = 88%). The ABC group had a significantly decreased number of debridements (SMD = -2.47, 95% CI -4.24 to -0.70, p < 0.00001, I² = 95%). The pooled data showed no significant difference (RR = 0.41, 95% CI 0.12 to 1.39, p = 0.84, I² = 0%).

Conclusion: This is the first meta-analysis comparing the efficacy of antibiotic-loaded bone cement for the treatment of infected diabetic foot. Antibiotic-loaded bone cement treatment significantly shortened the wound healing time and reduced the number of debridements without increasing the incidence of complications.

Trial registration: PROSPERO CRD42023406017.