Incidence and risk factors of recurrence in limb osteomyelitis patients after antibiotic‐loaded cement spacer for definitive bone defect treatment

Abstract

AimsThis study was designed to characterize the recurrence incidence and risk factors of antibiotic-loaded cement spacer (ALCS) for definitive bone defect treatment in limb osteomyelitis.MethodsWe included adult patients with limb osteomyelitis who received debridement and ALCS insertion into the bone defect as definitive management between 2013 and 2020 in our clinical centre. The follow-up time was at least two years. Data on patients’ demographics, clinical characteristics, and infection recurrence were retrospectively collected and analyzed.ResultsIn total, 314 patients with a mean age of 52.1 years (SD 12.1) were enrolled. After a mean of 50 months’ (24 to 96) follow-up, 53 (16.9%) patients had infection recurrence including 32 tibiae, ten femora, ten calcanea, and one humerus. Of all patients with recurrence, 30 (9.6%) occurred within one year and 39 (12.4%) within two years. Among them, 41 patients needed reoperation, five received antibiotics treatment only, and seven ultimately required amputations. Following multivariable analysis, we found that patients infected with Gram-negative bacilli were more likely to have a recurrence (odds ratio (OR) 2.38, 95% confidence interval (CI) 1.20 to 6.94; p = 0.046) compared to Staphylococcus aureus; segmental bone defects (OR 5.25, 95% CI 1.80 to 15.26; p = 0.002) and smoking (OR 3.00, 95% CI 1.39 to 6.50; p = 0.005) were also independent risk factors for recurrence after treatment.ConclusionPermanent ALCS might be an alternative strategy for definitive bone defect management in selected osteomyelitis cases. However, the overall high recurrence found suggests that it should be cautiously treated. Additionally, segmental defects, Gram-negative infections, and smoking were associated with an increased risk of infection recurrence.Cite this article: Bone Joint Res 2023;12(8):467–475.

Optimizing diagnosis and surgical decisions for chronic osteomyelitis through radiomics in the precision medicine era

“…Importantly, the radiomics-based SVM model can identify these subtle features accurately, improving diagnotic accuracy. Our findings are consistent with the widely accepted perspective that eradicating osteomyelitis necessitates expanding the surgical scope (Lazzarini et al, 2002;McNally et al, 2022;Wu et al, 2023). Our results indicate that expanding the delineation range from 0 to 5 mm substantially enhanced MRI radiomics' diagnostic performance in osteomyelitis, providing valuable insights for osteomyelitis surgical scope guidance.…”

“…KEYWORDS chronic osteomyelitis, radiomics, MRI, diagnostic accuracy, surgical decisionmaking, shape features, region of interest 1 Introduction Chronic osteomyelitis has long been recognized as one of the most challenging diseases in the medical field, often referred to as the "second cancer" (Zhang et al, 2019;Masters et al, 2022). Despite the refined antimicrobial activity of new-generation antibiotics and the efficacy of surgical intervention, the recurrence rate of chronic osteomyelitis remains as high as 20%-30% (Conterno and Turchi, 2013;Chastain and Davis, 2019;Zeitlinger, 2019;Wang X. et al, 2023).…”

The induced membrane technique for the management of infected segmental bone defects

“…However, segmental bone defects are also a risk factor for infection recurrence. 34 Therefore, in these patients, it may be beneficial to consider using other methods for bone defect reconstruction. After radical debridement, it is necessary to stabilize the broken end of the bone defect to provide a stable environment for induced membrane formation and infection control.…”

Analysis of risk factors for the recurrence of osteomyelitis of the limb after treatment with antibiotic-loaded calcium sulfate and autologous bone graft

“…Some scholars have found that the risk factors for the recurrence of limb osteomyelitis infection treated with induced membrane technology include repeated surgery, post-traumatic osteomyelitis, and one-stage fixation ( Wang et al, 2020 ). In addition, previous studies have shown that segmental bone defects, Gram-negative bacterial infections, and smoking are risk factors for infection recurrence in patients with osteomyelitis treated with antibiotic bone cement spacers ( Wu et al, 2023 ). Different treatment methods have different risk factors for the recurrence of osteomyelitis infection.…”