Management of Polymicrobial Cierny-Mader Grade 3 and 4 Chronic Osteomyelitis of the Femur

Abstract

Introduction Osteomyelitis refers to an inflammatory process affecting the bone and bone marrow. Chronic disease occurs following the formation of a necrotic, devascularised sequestrum. Regardless of the approach, treatment is complex and resource-intensive, often requiring multiple surgical interventions and extended antibiotic therapy. This study aims to review the treatment of chronic osteomyelitis of the femur by a single surgeon over seven years (January 2013 to January 2020). Materials and methods We retrospectively reviewed a consecutive series of 14 patients. Data collected includes age, sex, medical history, treatment, pathogen, C-reactive protein levels, outcome, and follow-up period. The EuroQOL five-dimensional questionnaire (EQ-5D-5L) and Visual Analogue Scale (EQ-VAS) were used to assess health outcomes. Data concerning total treatment costs and reimbursement received was also collected. Results Although 10/14 (71.4%) patients were considered in remission at final follow-up, only six (42.9%) achieved remission and showed no recurrence after initial treatment. The mean total treatment cost was £39,249.50, with a mean deficit of - £19,080.10 when considering reimbursement. Patients showed a significantly lower mean EQ-5D score (0.360) compared to the national population mean of 0.856 (P = .0018) as well as a lower mean EQ-VAS (61.7) compared to the population norm of 82.8 (P = .013).  Conclusion The extensive nature of the infection, high rates of co-morbidity, and the growth of more than a single pathogen may explain the lower success rate observed. In these patients, recurrence may be highly likely and thus regular follow-up is vital in order to ensure effective management.