Treatment of Chronic Bone Infection

The treatment of chronic osteomyelitis depends on the obstinate persistence of the offending micro-organism(s) and often results in long-term patient disability causing remarkable costs to the health care system. Difficulties of treating chronic osteomyelitis derive from biofilm-forming pathogens that resist the host immunologic defense and antimicrobial substances, and the need to treat osseous defects that result from the disease itself and eventual previous interventions. Established surgical techniques require multiple costly operations with extended periods of disablement and impairment of the patients, sometimes making the therapy worse than the disease. This article suggests a new operative approach to address biofilm-adapted antimicrobial therapy and reconstruction of bony defects using antibiotic-impregnated allograft bone. The technique is applicable to all stages of the Cierny-Mader classification, and detailed description of specifications for the respective procedure is provided. Local use of high antibiotic concentrations enable simultaneous internal fixation with osteosynthetic material and minimize the need for using systemic antibiotics. This treatment results in short hospital stays, reduced pain, and faster rehabilitation for patients, markedly reducing their burden and the costs of treatment. Recurrences may occur in 10% of cases, but may be treated by repeating the procedure.