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Risk factors associated with recurrence of extremity osteomyelitis treated with the induced membrane technique
Xiaohua Wang1, Shulin Wang1, Jingshu Fu1
1National & Regional United Engineering Laboratory of Tissue Engineering, Department of Orthopaedics, First Affiliated Hospital, Third Military Medical University (Army Medical University), Chongqing 400038, PR China.
Introduction:
Our aim was to observe the efficacy of the induced membrane technique in the treatment of extremity osteomyelitis and to analyse the causes of infection recurrence and its risk factors.
Methods:
We retrospectively analysed 424 cases of extremity osteomyelitis treated with the induced membrane technique in our department between May 2013 and June 2017. Infection recurrence time, recurrence sites and other relevant information were collected, summarized, and analysed.
Results:
A total of 424 patients were considered as "cured" of osteomyelitis after the first stage and the induced membrane technique was performed to rebuild the bone defects. After a mean follow-up of 31.6 (16-63) months, 52 patients had recurrence of infection, including 42 tibias and 10 femurs. The recurrence rate was 12.26%. Symptoms were relieved in 16 patients after intravenous antibiotic treatment. In the remaining 36 cases (8.49%), the infection was uncontrolled by intravenous antibiotics and surgical debridement was performed. The recurrence rate of infection of the tibia (16.22%) was higher than that of the femur (8.70%). The recurrence rate of post-traumatic osteomyelitis (14.66%) was significantly higher than that of hematogenous osteomyelitis (2.41%). Patients in whom Pseudomonas aeruginosa was isolated at the first stage had a recurrence rate of 28% (7/25), which was higher than that with the other isolated bacteria. Logistic regression analysis showed that repeated operations (≥3), post-traumatic osteomyelitis, and internal fixation at the first stage were risk factors for recurrence of infection, with odds ratios (ORs) of 2.30, 5.53 and 5.28 respectively.
Conclusions:
The induced membrane technique is an effective method in the treatment of extremity osteomyelitis, although infection recurs in some cases. Repeated operations, post-traumatic osteomyelitis, and internal fixation at the first stage were risk factors for recurrence of infection. P. aeruginosa isolated at the first stage, tibia osteomyelitis, the presence of sinus, or flaps may also be associated with recurrence of infection.
Insights
The induced membrane technique effectively treats extremity osteomyelitis, but infection recurrence can occur. Risk factors for recurrence include repeated operations and post-traumatic osteomyelitis.
Area of Science:
- Orthopedics
- Infectious Diseases
- Surgical Innovation
Background:
- Osteomyelitis of the extremities presents a significant clinical challenge.
- The induced membrane technique offers a reconstructive approach for bone defects post-infection.
Purpose of the Study:
- To evaluate the efficacy of the induced membrane technique for extremity osteomyelitis.
- To identify recurrence causes and risk factors associated with this treatment.
Main Methods:
- Retrospective analysis of 424 extremity osteomyelitis cases treated with the induced membrane technique.
- Data collection on recurrence, treatment outcomes, and risk factor analysis using logistic regression.
Main Results:
- A 12.26% recurrence rate was observed after a mean follow-up of 31.6 months.
- Tibia osteomyelitis (16.22%) and post-traumatic osteomyelitis (14.66%) showed higher recurrence rates.
- Risk factors for recurrence included repeated operations (≥3), post-traumatic origin, and internal fixation (ORs 2.30-5.28).
Conclusions:
- The induced membrane technique is effective for extremity osteomyelitis, but recurrence is possible.
- Key risk factors for recurrence are repeated surgeries, post-traumatic etiology, and initial internal fixation.
- Pseudomonas aeruginosa infection, tibia location, sinus presence, or flaps may also correlate with recurrence.
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