Takeout or delivery? Reoperation rates in lower extremity long bone osteomyelitis treated with debridement and local antibiotic delivery systems

Background: Early diagnosis and treatment of osteomyelitis is essential to prevent potential complications including sepsis, extensive bone resection, amputation, and death. Despite current treatment strategies for management of osteomyelitis, recurrence rates reported in the literature are upwards of 25 %. Current evidence comparing the efficacy of differing surgical treatments of osteomyelitis is inconclusive. The purpose of this study is to compare rates of re-debridement and amputation in patients who receive either debridement alone or debridement with placement of local antibiotic delivery systems as initial treatment for lower extremity long bone osteomyelitis.

Methods: A retrospective cohort study was performed to investigate complication rates after surgical treatment methods for osteomyelitis of the femur and tibia. The rates of re-debridement and amputation were compared in patients who received either debridement alone or debridement with placement of local antibiotic delivery systems.

Results: This study reports 73 % lower rates of re-debridement after debridement and local antibiotic delivery in tibial osteomyelitis, and 83 % lower rates of re-debridement after debridement and placement of local antibiotic delivery systems in femoral osteomyelitis compared to debridement alone. There was no significant difference in amputation rates between treatment groups for either tibial (7.4 vs 5.7 %; OR: 1.31; 95 % CI, 0.92-1.87) or femoral osteomyelitis (2.4 vs 1.4 %; OR: 1.65; 95 % CI, 0.71-4.01).

Conclusion: There was a significantly decreased likelihood of re-debridement for patients who underwent initial treatment with combined debridement and placement of antibiotic delivery systems compared to debridement alone. Providers may consider this when comparing treatment options for their patients with lower extremity osteomyelitis.