Abstract
BACKGROUND: Partial calcanectomy is an established alternative to amputation in diabetic calcaneal osteomyelitis, with recent studies utilising adjuvant local antibiotic delivery devices to improve outcomes. The Silo technique is a novel approach involving an antibiotic-loaded hydroxyapatite calcium sulphate bioceramic (Cerament G or V) implanted into pre-drilled holes in the calcaneus. METHOD: This retrospective case series involved 30 patients with chronic diabetic calcaneal osteomyelitis that underwent partial calcanectomy with Cerament G or V application via the Silo technique between 2014 and 2024. Patients were further followed up on their ambulatory status via telephone consultation. Primary outcomes were infection eradication, ulcer healing, limb salvage, patient mortality and ambulatory status. RESULTS: Infection eradication was achieved in 29 (97%) patients, ulcer healing in 27 (90%), and limb salvage in 28 (93.3%). Ulcer recurrence occurred in 8 (26.7%) patients. The all-cause mortality rate was 6.7% at 1-year and 43.3% at 5-years. With regards to ambulatory status, 6 (20.0%) patients improved their ambulatory status from baseline, 20 (66.7%) maintained their baseline ambulatory status, and 4 (13.3%) deteriorated in ambulatory status from baseline. CONCLUSION: The Silo technique for diabetic calcaneal osteomyelitis demonstrates promising clinical outcomes, including infection eradication, ulcer healing, ulcer recurrence, limb salvage, 1-year mortality, and mobility. Further prospective studies with larger cohorts and randomised controlled trials are warranted to validate these exploratory findings and to better understand the factors influencing both short and long-term outcomes.