Strategies in Trauma and Limb Reconstruction

Register      Login

VOLUME 11 , ISSUE 2 ( August, 2016 ) > List of Articles

Original Article

The outcome of treatment of chronic osteomyelitis according to an integrated approach

Leonard C. Marais, Colleen Aldous, Theo L. B. Le Roux

Keywords : Osteomyelitis, Chronic, Classification, Outcome, Management

Citation Information : Marais LC, Aldous C, Le Roux TL. The outcome of treatment of chronic osteomyelitis according to an integrated approach. 2016; 11 (2):135-142.

DOI: 10.1007/s11751-016-0259-1

License: CC BY-NC-SA 4.0

Published Online: 01-06-2014

Copyright Statement:  Copyright © 2016; The Author(s).


Abstract

Previous classification systems of chronic osteomyelitis have failed to provide objective and pragmatic guidelines for selection of the appropriate treatment strategy. In this study, we assessed the short-term treatment outcome in adult patients with long-bone chronic osteomyelitis prospectively where a modified host classification system was integrated with treatment strategy selection through a novel management algorithm. Twenty-six of the 28 enrolled patients were available for follow-up at a minimum of 12 months. The median patient age of was 36.5 years (range 18–72 years). Fourteen patients (54 %) were managed palliatively, and 11 patients (42 %) were managed through the implementation of a curative treatment strategy. One patient required alternative treatment in the form of an amputation. The overall success rate was 96.2 % (95 % CI 80.4–99.9 %) at a minimum of 12-months follow-up. Remission was achieved in all [11/11] patients treated curatively (one-sided 95 % CI 73.5–100.0 %). Palliative treatment was successful in 92.9 % [13/14] of cases (95 % CI 66.1–99.9 %). In patients with lower limb involvement, there was a statistically significant improvement of 28.3 (95 % CI 21.0–35.7; SD 17.0) in the AAOS Lower Limb Outcomes Instrument score (p value < 0.001). The integrated approach proposed in this study appears a useful guideline to the management of chronic osteomyelitis of long bones in adult patients in the developing world. Further investigation is required to validate the approach, and additional development of the algorithm may be required in order to render it useful in other clinical environments.


PDF Share
  1. Galanakos SP, Papadakis SA, Kateros K, Papakostas I, Macheras G (2009) Biofilm and orthopaedic practice: the world of microbes in a world of implants. Orthop Trauma 23(3):175-179
  2. Boyce BF, Xing L, Schwarz EM (2011) The role of the immune system and bone cells in acute and chronic osteomyelitis. In: Lorenzo J, Choi Y, Horowitz M, Takayanagi H (eds) Osteoimmunology: interactions of the immune and skeletal systems, 1st edn. Academic Press, Waltham, pp 369-390
  3. Walter G, Kemmerer M, Kappler C, Hoffmann R (2012) Treatment algorithms for chronic osteomyelitis. Dtsch Arztebl Int 109(14):257-264
  4. Marais LC, Ferreira N, Aldous C, Le Roux TLB (2014) Classification of chronic osteomyeltis. S Afr J Orthop 13(1):22-28
  5. Roa N, Ziran BH, Lipsky BA (2011) Treating osteomyelitis: antibiotics and surgery. Plast Reconstr Surg 127(Suppl):177S- 187S
  6. Romanò CL, Romanò D, Logoluso N, Drago L (2011) Bone and joint infections in adults: a comprehensive classification proposal. Eur Orthop Traumatol 1:207-217
  7. Cierny G, Mader JT, Penninck JJ (2003) A clinical staging system for adult osteomyelitis. Clin Orthop Relat Res 414:7-24
  8. Lazzarini L, Lipsky BA, Mader JT (2005) Antibiotic treatment of osteomyelitis: what have we learned from 30 years of clinical trials? Int J Infect Dis 9:127-138
  9. McNally M, Nagarajah K (2010) Osteomyelitis. Orthop Trauma 24(6):416-429
  10. Cierny G (2011) Surgical treatment of osteomyelitis. Plast Reconstr Surg 127(Suppl 1):S190-S204
  11. Lazzarini L, Mader JT, Calhoun JH (2004) Osteomyelitisin Long Bones. J Bone Jt Surg Am 86(10):2305-2318
  12. Beaton DE, Wright JG, Katz JN, the Upper Extremity Collaborative Group (2005) Development of the QuickDASH: comparison of three item-reduction approaches. J Bone Jt Surg Am 87(5):1038-1046
  13. Johanson NA, Liang MH, Daltroy L, Rudicel S, Richmond J (2004) American academy of orthopaedic surgeons lower limb outcomes assessment instruments. Reliability, validity, and sensitivity to change. J Bone Jt Surg Am 86(5):902-909
  14. Cierny G, DiPasquale D (2002) Periprosthetic total joint infections. Staging, treatment, and outcomes. Clin Orthop Relat Res 403:23-28
  15. Lautenbach E (1975) Chronic Osteomyelitis: irrigation and suction after surgery. J Bone Jt Surg Br 57(2):259
  16. Hashmi MA, Norman P, Saleh M (2004) The management of chronic osteomyelitis using the Lautenbach method. J Bone Jt Surg Br 86:269-275
  17. Hall BB, Fitzgerald RH, Rosenblatt JE (1984) Anaerobic osteomyelitis. J Bone Jt Surg Am 65:30-35
  18. Conterno L, Turchi MD (2013) Antibiotics for treating chronic osteomyelitis in adults. Cochrane Database Syst Rev. doi:10.1002/14651858.CD004439.pub3
  19. Marais LC, Ferreira N, Sartorius B, Aldous C, Le Roux TLB (2015) A modified staging system for chronic osteomyelitis. J Orthop 12:184-192. doi:10.1016/j.jor.2015.05.017
  20. Sheehy SH, Atkins BA, Bejon P, Byren I, Wyllie D, Athanasou NA et al (2010) The microbiology of chronic osteomyelitis: prevalence of resistance to common empirical anti-microbial regimens. J Infect 60:338-343
PDF Share
PDF Share

© Jaypee Brothers Medical Publishers (P) LTD.