Surgical Treatment and Outcomes of Calcaneal Osteomyelitis in Adults: A Systematic Review

Abstract

Abstract. Introduction: Calcaneal osteomyelitis is an uncommon and challenging condition. In this systematic review we aim to analyse the outcomes from concomitant use of bone debridement and soft tissue management for patients diagnosed with calcaneal osteomyelitis.Materials & Methods: A complete computerised and comprehensive literature search of Pubmed and Cochrane database was undertaken from January 2000 to October 2018. During the review, studies were screened for information about the surgical and antimicrobial treatment, the complications, the reinfection rate and the functional outcome of patients with calcaneal osteomyelitis.Results: Of the 20 eligible studies included, seven (35%) described bone treatment only, six (30%) soft tissue treatment only, five (25%) soft tissue and bone treatment, and two (10%) focused on prognostic factors and differences in outcomes between diabetic and non-diabetic patients.In the studies with bone treatment only, infection recurrence ranged from 0 to 35% and the amputation rate from 0 to 29%. If soft tissue coverage was also needed, both the reinfection rate and amputation rate ranged from 0 to 24%. Studies presenting the functional status generally showed preservation or even improvement of the preoperative ambulatory status.Conclusion: Calcaneal osteomyelitis is difficult to treat. A multidisciplinary approach involving orthopaedic surgeons, plastic surgeons and infectious disease physicians is preferred. The heterogenicity of studies has hindered the development of agreed treatment protocols, which would be useful in clinical practice.

Single-stage debridement with implantation of antibiotic-loaded calcium sulphate in 34 cases of localized calcaneal osteomyelitis

“…Even a recent study (Waibel et al 2019 ) showed that 50% of the CO patients had to undergo secondary below-knee amputation even if they had already received total calcanectomy. The optimal surgical strategy for CO remains controversial (Sabater-Martos et al 2019 ). We have reported the outcomes of the cortical bone windowing followed by eggshell-like debridement and local vancomycin- and gentamicin-loaded CS for the treatment of patients with type III CO. Our findings can be summarized under the following 4 aspects.…”

“…The successful treatment of CO with limb salvage remains a challenge, primarily being attributable to the unique anatomical structure and function of the calcaneus, with limited surrounding soft tissue and blood supply. Clinical efficacy remains unsatisfying, with high risks of infection relapse and amputation (Merlet et al 2014 , Sabater-Martos et al 2019 , Waibel et al 2019 ).…”

The epidemiology and clinical features of calcaneus osteomyelitis following calcaneus fracture: a retrospective study of 127 cases

“…A study on the surgical outcomes of intraarticular calcaneal fractures found that patients aged >30 years had poor outcomes compared with those under 30 years, thus leading to complication (14). Additionally, age >65 years is an important risk factor of calcaneus osteomyelitis (15). Healthy patients who develop osteomyelitis following a traumatic injury have the highest chance of recovering at young age (8).…”

MRI of the Achilles tendon – a comprehensive pictorial review. Part two

“…18 ) may be a complication of any intervention, and it is usually a clinical diagnosis. Diagnostic imaging and bacteriological analysis are applied to confirm the diagnosis and to find the etiology [ 23 ]. Symptoms most often appear sometime after the procedure.…”

“…In the early stages, it is challenging to differentiate between infection and postoperative changes on MRI. Osteomyelitis of the calcaneus is seen as bone marrow edema with contrast enhancement [ 23 ]. If an abscess is present, a central fluid collection, destruction of bone and extensive contrast enhancement are visible.…”