Journal of Clinical and Basic Research (Jan 2023)
A study of relapse rate and functional outcome after surgical debridement in patients with chronic osteomyelitis
Abstract
Background: This study analyzed the rate of relapse and functional outcome after surgery for chronic osteomyelitis of long bones. Methods: This study included 100 cases of chronic osteomyelitis, which were treated with surgical debridement, along with a 6-week course of antibiotics. The patients were divided into two groups based on whether they had undergone preoperative magnetic resonance imaging (MRI) or not. A comparison of relapse rates was then conducted between these two groups. The patients were followed up, and their functional outcomes were examined using the Association for the Study and Application of the Method of Ilizarov Criteria (ASAMI), Lower Extremity Functional Scale (LEFS), Disabilities of the Arm, Shoulder, and Hand (DASH), and Musculoskeletal Tumor Society (MSTS) questionnaires. Logistic regression analysis was used to assess the impact of risk factors on the recurrence or relapse. Results: Sixty patients had chronic osteomyelitis, and 40 patients were infected non-union. Twenty-five patients had preoperative MRI. The mean preoperative LEFS was 44 ± 13.59 (19-73). Preoperative ASAMI showed 4% excellent, 62% fair, 24% good, and 10% were poor. The preoperative MSTS emotional component showed that enthusiastic (0%), satisfied (0%), accepts (36%), and dislikes (60%). Among the infected non-union cases, 2 cases had a total disability, 15 cases had recreational restriction, and 23 cases had a partial disability. Majority cases were gram-positive organism cultured were methicillin-sensitive Staphylococcus aureus accounts 21%, and methicillin-resistant S. aureus accounts 16%. Common antibiotics administered were Cloxacillin in 23 cases, Meropenem in 11 cases, Septran in 8 cases, Linezolid in 8 cases, and Vancomycin in 7 cases. The mean duration of antibiotics administered was 6 weeks. At 1 year postoperative, ASAMI showed a reduction in the number of patients categorized as 'fair' from 12 to 9, while the number of patients classified as 'good' increased from 2 to 6 cases. Fourteen (66.6%) patients who were initially classified under the 'fair' or 'poor' category preoperatively decreased to 9 (42.8%) postoperatively. The number of patients in the 'good' category increased from 6 (28%) preoperatively to 9 (42.9%) at the 6-month postoperative mark. Of the 61 patients, 42 (64.6%) had significant functional improvement at 1 year postoperative among those who had chronic osteomyelitis, while of the 34 patients, 15 (44.1%) patients with infected non-union had significant functional improvement (P = 0.04). 20.7% out of 77 patients who were culture positive went on to have relapse within 1 year follow-up and 15% out of the 20 patients who had no-growth on intraoperative cultures went on to develop relapse following one year post surgery follow-up. Nine patients (24.3%) in the posttraumatic group had recurrence of infection, while 1 patient had relapse at 6 months following surgery. At the 6-month follow-up, the percentage of relapse was 13.3% (n = 2) in the MRI group and 25% (n = 8) in the non-MRI group. Conclusion: The relapse rate was 19.8%. In total, 19.3% of surgical debridement had experienced a recurrence of infection within the first year of follow-up, and 7.3% of patients required repeat surgery during the hospital stay. Factors that determined recurrence were age > 55 years, long bone involvement, fracture, monotherapy, receiving < 6 weeks of antibiotics, and inadequate treatment. Disease burden, financial conflicts, disability, and long duration of treatment affect the patient’s emotional status. These factors may also affect the patient's compliance with the prescribed treatment plan.
