Chronic osteomyelitis is a difficult therapeutic problem, frequently resulting in long term disability. There are many facets of chronic osteomyelitis (eg. regional hypovascularity, soft tissue coverage, necrotic tissue and specific pathogenic organisms) all of which must be addressed if eradication of infection is to be achieved. As part of the therapy for osteomyelitis we have recently used local antibiotic administration via an implantable pump. An infusion pump is implanted subcutaneously in the ipsilateral lower quadrant of the abdomen. The outflow catheters of the pump are brought subcutaneously to the infected area and inserted in the osteomyelitic defect. The pump is filled at weekly intervals as an outpatient. We propose comparing this method of local administration of antibiotics with systemic intravenous administration in the treatment of chronic osteomyelitis. In addition to antibiotic therapy all patients will require surgical management, eg: debridement; soft tissue coverage; and stabilization of nonunions. The project director will perform all surgical procedures on patients included in the study. Only patients with a similar degree of severity of osteomyelitis, based on a classification scheme proposed by Cierny (1), of the femur or tibia will be included in the study to ensure a controlled treatment group. Efficacy of therapy will be evaluated according to the following parameters: (1) local and systemic levels of antibiotic; (2) incidence of side effects; (3) duration of hospitalization; (4) cost of therapy; and, (5) incidence of suppression or eradication of infection.
| Perry, C R; Pearson, R L; Miller, G A (1991) Accuracy of cultures of material from swabbing of the superficial aspect of the wound and needle biopsy in the preoperative assessment of osteomyelitis. J Bone Joint Surg Am 73:745-9 |
