J Bone Jt Infect 2019; 4(6):306-313. doi:10.7150/jbji.40337

Research Paper

Chronic Osteomyelitis of the tibia and ankle treated with Limb Salvage Reconstruction

Aaron Lam1✉, Shawn S. Richardson2, Josh Buksbaum3, Jonathan Markowitz4, Michael W. Henry5, Andy O. Miller5, S Robert Rozbruch2, Austin T. Fragomen2

1. Maimonides Medical Center, 4802 10th Ave, Brooklyn, NY 11219, USA.
2. Limb Lengthening and Complex Reconstruction Service, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021, USA.
3. Emory University, 201 Dowman Dr, Atlanta, GA 30322, USA.
4. Rush Medical College, 600 S. Paulina St., Chicago, IL 60612 USA.
5. Infectious Disease Service, Hospital for Special Surgery, Weill Cornell Medical College, 535 East 70th Street, New York, NY 10021, USA.

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Citation:
Lam A, Richardson SS, Buksbaum J, Markowitz J, Henry MW, Miller AO, Rozbruch SR, Fragomen AT. Chronic Osteomyelitis of the tibia and ankle treated with Limb Salvage Reconstruction. J Bone Jt Infect 2019; 4(6):306-313. doi:10.7150/jbji.40337. Available from http://www.jbji.net/v04p0306.htm

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Abstract

Introduction: To confirm the success of our limb salvage treatment protocol and determine what factors are predictive of success versus failure in limb salvage techniques for patients with chronic osteomyelitis of the tibia and ankle.

Methods: Retrospective case series analyzing factors and outcomes in patients who underwent limb salvage techniques for chronic osteomyelitis of tibia or ankle. Main outcome measurements included infection controlled without the need for amputation or chronic antibiotic suppression and union of infected non-unions.

Results: Mean follow-up was 3.9 years. Out of the sixty-seven patients (mean age: 51.4 years) treated for chronic osteomyelitis, fifty-four had an associated non-union. Sixty-one patients (91.0%) had their infection controlled by limb salvage. Five ultimately required amputation and one remained on daily chronic antibiotics. Diabetics complicated with neuropathy and increasing numbers of limb salvage surgeries were associated with a significantly higher failure rate. Forty-eight out of fifty-four patients (88.9%) also had successful healing of their infected non-union. Diabetes and need for more limb salvage surgeries were also found to have a significantly higher failure rate.

Conclusions: Limb salvage is a reliable and successful treatment for patients with chronic osteomyelitis and infected non-unions of the lower extremities. Diabetic neuropathy is a risk factor that impedes success.

Level of Evidence: Prognostic Level IV.

Keywords: chronic osteomyelitis, limb salvage, limb preservation, amputation, tibia, ankle