Association of Magnetic Resonance Imaging-Guided Management With Reamputation Rates in Diabetic Foot Osteomyelitis

Area of Science:

• Diabetic foot complications
• Orthopedic surgery
• Radiology

Background:

• Diabetic foot infections lead to 80% of annual amputations.
• Diabetic foot osteomyelitis is a common complication requiring amputation.
• Magnetic resonance imaging (MRI) staging may reduce reamputation rates.

Purpose of the Study:

• To analyze the risk of reamputation in diabetic foot osteomyelitis patients.
• To compare MRI-guided therapy with non-MRI-guided therapy.
• To evaluate the impact of proximal surgical margin pathology on reamputation risk.

Main Methods:

• Retrospective chart review of 386 veterans (2005-2022).
• Comparison of MRI-guided therapy (n=89) versus non-MRI-guided therapy (n=297).
• Primary outcome: reamputation rate within 365 days.

Main Results:

• MRI-guided therapy significantly decreased reamputation rates (15.7% vs 32.3%, P=.0024).
• MRI-guided therapy was associated with a reduced relative risk of reamputation (HR 0.47, P=.0098).
• Proximal margin pathology did not correlate with reamputation risk (HR 1.25, P=.31).

Conclusions:

• Preamputation MRI and MRI-guided therapy may reduce 1-year reamputation risk.
• Incorporating MRI enhances diagnostic and treatment strategies for diabetic foot osteomyelitis.
• MRI-guided treatment offers a promising approach to limb salvage in diabetic patients.