The influence of foreign body surface area on the outcome of chronic osteomyelitis

• We model chronic osteomyelitis in rabbits using different infection promoters.
• Cotton-mesh-foreign-body rabbit group had the shortest disease on-set time interval.
• Cotton-mesh-foreign-body rabbit group had the highest survival rate.
• Cotton-mesh-foreign-body rabbit group had the highest disease reproduction rate.
• Cotton-mesh-foreign-body rabbit group—the most suitable for further treatment studies.

Reproducible animal models of osteomyelitis close to the clinical scenario are difficult to obtain as the animals either die shortly after inoculation of bacteria or the bone cures itself of infection. Additional materials used as foreign bodies offer increased chances for localized infection due to bacterial attachment and are closer to clinical pathology.Through in vivo experimentation we investigated here the influence of surface area of a series of foreign bodies on the final outcome of the animal model, in terms of reproducibility, survival rate and time necessary for onset of chronic disease. Stainless steel Kirschner wire segments, stainless steel balls and cotton meshes were employed for this purpose.The clinical, microbiological, radiological and histological results obtained were compared with the simple case where no foreign body was used. The follow-up period was 57 days. The cotton meshes, which had the highest surface area, were observed to provide the best outcome, with the lowest disease onset time interval (of 1 week earlier than the others), the highest survival (of 90%) and disease reproduction rate (90%). The only clinical pattern of the mesh group rabbits was short lived inflammation while the other rabbits presented also some other clinical signs such as rhinorrheas, abscesses, rush and/or dyspnea. Moreover, this model is the most suitable for further treatment studies, as the cotton meshes could be easily removed after disease onset, without any intervention on the bone. This is important, as the treatment would address the bacteria present within the bone parts (marrow, cortex, periosteum etc.) not those forming the biofilm.