Abstract
Aim
Despite advances in surgical and antibiotic therapies the treatment of chronic osteomyelitis remains complex and is often associated with a significant financial burden to the National Health Service. The aim of this review was to identify the different types of single-stage procedures being performed for this condition as well as to evaluate their effectiveness.
Method
Ovid Medline and Embase databases were searched for articles on the treatment of chronic osteomyelitis over the last 20 years. 3511 journal abstracts were screened by 3 independent reviewers. Following the exclusion of paediatric subjects, animal models, non-bacterial osteomyelitis and patients undergoing multiple surgical procedures we identified 13 studies reported in English with a minimum follow up of 12 months. Following a quality assessment of each study, data extraction was performed and the results analysed.
Results
505 patients with chronic osteomyelitis underwent attempted single-stage procedures. Following debridement a range of techniques are described to eliminate the remaining dead space. These include musculocutaneous flaps, insertion of S53P4 glass beads or packing with antibiotic loaded ceramic or calcium-sulphate pellets. The average follow-up ranged from 12 to 110 months. The most common organism isolated was Staphylococcus Aureus. Success was defined as resolution of pain with no recurrence of sinuses and no need for a second procedure to treat infection. Success rates ranged from 60%-100%.
Conclusions
There are currently a wide range of single-stage procedures being performed for chronic osteomyelitis with varying success rates. Treating patients with these methods in specialist centres can result in resolution of infection and may lead to improved quality of life for the patient and a financial saving for the National Health Service. So far no one technique has been shown to be superior and further long term follow up data is required.
