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Abstract
Background and Purpose: A case series review of chronic pelvic osteomyelitis treated with combined medical and surgical treatment by a multidisciplinary team.Methods: All patients treated with surgical excision of pelvic osteomyelitis at our tertiary referral centre between 2002 and 2014 were included. All received combined care from a clinical microbiologist, an orthopaedic surgeon and a plastic surgeon. The rate of recurrent infection, wound healing problems and post-operative mortality was determined in all. Treatment failure was defined as reoperation involving further bone debridement, a requirement for the use of long-term suppressive antibiotics or sinus recurrence.Results: Sixty-one adults (mean age 50.2 years, range 16.8-80.6) underwent surgery. According to the Cierny-Mader classification of osteomyelitis there were 19 type II, 35 type III and 7 type IV cases. The ischium was the most common site of infection. Osteomyelitis was usually the result of contiguous focus infection associated with decubitus ulcers, predominantly in patients with spinal or cerebral disorders. Most patients with positive microbiology had polymicrobial infection (52.5%). Thirty patients required soft tissue reconstruction with muscle or myocutaneous flaps.Twelve deaths occurred a mean of 2.8 years following surgery (range 7 days-7.4 years). Excluding these deaths the mean follow-up was 4.6 years (range 1.5-12.2 years). Recurrent infection occurred in seven (11.5%) a mean of 1.5 years post-operatively (92 days - 5.3 years). After further treatment 58 cases (95.1%) were infection free at final follow-up.Interpretation: Patients in this series have many comorbidities and risk factors for poor surgical outcome. Nevertheless, the multidisciplinary approach allows successful treatment in the majority of cases.
Highlights
Chronic osteomyelitis is a debilitating condition which may require prolonged periods of multidisciplinary treatment to effect cure or control symptoms
41/61 cases in this series (67.2%) had osteomyelitis associated with pressure ulcers. 39 of these were affected by central nervous system injury or pathology causing paraparesis or tetraparesis as follows: 17 patients had traumatic spinal injury; 10 patients had spina bifida; seven patients had multiple sclerosis; three had undergone previous spinal tumour excision and two had other neurologic pathologies
Of the other two remaining cases with pressure ulcers, both developed these following a period of immobility caused by ill health; the first following surgery and radiotherapy for anal carcinoma and the second following recovery from a chest infection
Summary
Chronic osteomyelitis is a debilitating condition which may require prolonged periods of multidisciplinary treatment to effect cure or control symptoms. In the presence of dead bone, infection cannot be successfully eradicated with antibiotics alone due to causative organisms' ability to establish a biofilm In this glycocalyx matrix, bacteria with altered phenotype become tolerant of antimicrobials and relatively resistant to attack by the host immune system [1]. Spinal injury is a risk factor for pressure ulcers, with up to a third of patients affected [3, 4]. These patients typically have multiple comorbidities which complicate surgical recovery [3,4,5]. A case series review of chronic pelvic osteomyelitis treated with combined medical and surgical treatment by a multidisciplinary team
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