Abstract:
Previous classification systems of chronic
osteomyelitis have failed to provide objective and pragmatic
guidelines for selection of the appropriate treatment
strategy. In this study, we assessed the short-term treatment
outcome in adult patients with long-bone chronic
osteomyelitis prospectively where a modified host classification
system was integrated with treatment strategy
selection through a novel management algorithm. Twentysix
of the 28 enrolled patients were available for follow-up
at a minimum of 12 months. The median patient age of was
36.5 years (range 18–72 years). Fourteen patients (54 %)
were managed palliatively, and 11 patients (42 %) were
managed through the implementation of a curative treatment
strategy. One patient required alternative treatment in
the form of an amputation. The overall success rate was
96.2 % (95 % CI 80.4–99.9 %) at a minimum of
12-months follow-up. Remission was achieved in all [11/
11] patients treated curatively (one-sided 95 % CI
73.5–100.0 %). Palliative treatment was successful in
92.9 % [13/14] of cases (95 % CI 66.1–99.9 %). In
patients with lower limb involvement, there was a statistically
significant improvement of 28.3 (95 % CI 21.0–35.7; SD 17.0) in the AAOS Lower Limb Outcomes Instrument score (p value\0.001). The integrated
approach proposed in this study appears a useful guideline
to the management of chronic osteomyelitis of long bones
in adult patients in the developing world. Further investigation
is required to validate the approach, and additional
development of the algorithm may be required in order to
render it useful in other clinical environments.
