Contemporary treatment of chronic osteomyelitis: implementation in low- and middle-income countries

  • J Geurt Maastricht University
  • T Vranken Maastricht University
  • F Gabriels Maastricht University
  • J J Arts Maastricht University
  • P Moh St John of God Hospital
Keywords osteomyelitis, bio-active glass, biomaterial,, low- and middle-income countries

Abstract

Aim: Chronic osteomyelitis is still a difficult problem to treat in the developed world, but even more so in low- and middle-income countries. Contemporary treatment options result in satisfying outcomes in a setting with abundant resources, but the question is whether these treatment options can be translated to other, less supported health care systems and if they obtain the same results.


Methods: Eighteen patients with established chronic osteomyelitis (eight type III, ten type IV) were prospectively enrolled and treated in a one-stage procedure with radical debridement and dead space management using bioactive glass S53P4 granules, together with adjuvant antibiotic therapy.


Results: Thirteen patients were assessed at 24 months. Infection control was achieved in five patients (38%). Eight patients (61.5%) had persistence or recurrence of infection. Loss to follow-up was substantial (five patients, 28%). 


Conclusion: Due to specific challenges treating chronic osteomyelitis in low- and middle-income countries, contemporary treatment options cannot be ‘copy-pasted’ with the same results in these settings.


Level of evidence: Level 4

Author Biographies

J Geurt, Maastricht University

MD

Attending Orthopaedic Surgeon

Department of Orthopaedic Surgery

CAPHRI School of Public Health and Primary Care

Maastricht University

Maastricht

The Netherlands

T Vranken, Maastricht University

MSc

Medical Student

Department of Orthopaedic Surgery

CAPHRI School of Public Health and Primary Care

Maastricht University

Maastricht

The Netherlands

F Gabriels, Maastricht University

MSc

Department of Orthopaedic Surgery

CAPHRI School of Public Health and Primary Care

Maastricht University

Maastricht

The Netherlands; and

Orthopaedic Biomechanics Group

Department of Biomedical Engineering

Eindhoven University of Technology (TU/e)

The Netherlands

J J Arts, Maastricht University

PhD

Department of Orthopaedic Surgery

CAPHRI School of Public Health and Primary Care

Maastricht University

Maastricht

The Netherlands; and

Associate Professor

Orthopaedic Biomechanics Group

Department of Biomedical Engineering

Eindhoven University of Technology (TU/e)

The Netherlands

P Moh, St John of God Hospital

MD

Attending Orthopaedic Surgeon

St John of God Hospital

Duayaw Nkwanta

Ghana

Published
2018-05-22
How to Cite
GEURT, J et al. Contemporary treatment of chronic osteomyelitis: implementation in low- and middle-income countries. South African Orthopaedic Journal, [S.l.], p. 40-43, may 2018. ISSN 2309-8309. Available at: <http://journal.saoa.org.za/index.php/saoj/article/view/218>. Date accessed: 15 aug. 2018.
Section
Orthopaedic Oncology and Infections