Antibiotic cement achieves 85.2% healing rate in diabetic foot osteomyelitis meta-analysis

Photo by isens usa / Unsplash

Foot & ankle specialist Published June 1, 2026 Medically reviewed June 1, 2026 Study authors: Yammine Kaissar, Mansour Jad, Otayek Joeffroy, Alqaysi Bilal, Daher Jimmy, Assi Chahine PubMed ↗ DOI ↗ By Dr. Amelia Tan, PhD · Internal Medicine & Chronic Disease

Key Takeaway

Consider antibiotic-impregnated cement as a limb-preserving option for diabetic foot osteomyelitis, but evidence is limited.

This systematic review and meta-analysis evaluated the use of antibiotic-impregnated cement in diabetic foot osteomyelitis, pooling data from 82 patients with 85 procedures. The primary outcome was a weighted healing rate of 85.2%. Among secondary outcomes, cement was kept in place in 63.6% of cases, exchanged in 8.2%, and removed in 24.4%. Minor amputation following cement placement occurred in 13.4% of patients, and secondary surgery was needed in 18.7%.

Safety data were limited to reported events: minor amputation (13.4%) and secondary surgery (18.7%). Serious adverse events and tolerability were not reported. Cement exchange (8.2%) and removal (24.4%) were considered discontinuations of the initial cement strategy.

The authors note that the analysis is limited by the small number of available studies, and the evidence is graded as Level IV. No comparator group was reported, and funding or conflicts were not disclosed.

Clinically, antibiotic-impregnated cement may offer a non-radical limb-preserving option by providing local infection control and mechanical support for ambulation. However, the low certainty of evidence and lack of comparative data warrant cautious interpretation.

Study Details

Study typeMeta analysis

Sample sizen = 82

EvidenceLevel 1

Follow-up14.6 mo

PublishedJun 2026

PMID42089515

View Original Abstract ↓

BackgroundDiabetic foot infections are difficult to eradicate and could lead to serious complications such as multiple surgeries, amputation and mortality. Culture-based IV antibiotics and particularly amputation are usually the available options. Only few studies articles reported the use of cement impregnated with antibiotics to fill temporarily or permanently a bone defect, but with no evidence synthesis yet. Therefore, this study aims at assessing the outcomes of the use of antibiotic-impregnated cement for infection or mechanical support in diabetic foot osteomyelitis.MethodsA systematic review was performed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analysis. We searched multiple electronic databases using the terms "osteomyelitis AND cement AND diabetic AND foot." The quality of the included studies was evaluated using the Joanna Briggs Institute Appraisal Tool.ResultsSix studies met the inclusion criteria combining 82 patients with 85 procedures. With a mean follow-up period of 22 ±14.6 months, the meta-analytical results were as follows: (1) the weighted healing rate was 85.2%, (2) 63.6% of cement were kept in place, (3) 8.2% of cement had to be exchanged, (4) 24.4% of placed cement had to be removed, (5) minor amputation following cement placement was 13.4%, and (6) the rate of secondary surgery was 18.7%, with arthrodesis being the most common (94%).ConclusionThere are limited studies available detailing the outcomes of cement use in diabetic foot osteomyelitis. In the case of the difficult-to-heal osteomyelitis of the diabetic foot and whenever a peripheral bone rim could be preserved, filling the void within to deliver local infection control and to assure mechanical resistance for ambulation could be a non-radical limb preserving option.Level of EvidenceLevel IV.