Osteomyelitis is a term describing bone infection. It can be acute or chronic depending on the duration of the infection. Bone and joints can get infected with or without previous injury or surgery.
In theory, anyone can develop Osteomyelitis however some people are at higher risk than others. Some of those at high risk include:
• People who have recently broken a bone, in particular those who have suffered an open fracture.
• People who have recently had surgery to a bone.
• People with chronic health conditions such as Diabetes or Chronic kidney disease.
• People with a poor or weakened immune system e.g. on chemotherapy or steroids.
Symptoms of bone and joint infections are similar to any other infection i.e hot, red and painful area, or painful movement of the joint) but take longer to develop. It can take weeks if not months before these symptoms become obvious. In some cases, the symptoms are so subtle that it is almost impossible to recognise them. Therefore, the main factor in the diagnosis of bone and/or joint infection is a high risk of suspicion unless the symptoms are obvious and fast progressing.
As part of your hospital admission, you will undergo the following in order to diagnose Osteomyelitis:
• Physical examination
• Medical history taking
• Blood tests
• Bone scan
• Computed tomography (CT) scan
• Magnetic resonance imaging (MRI)
• Bone tissue biopsy.
Treatment for infected bone and joints basically consists of two options: 1) Debridement of the bone and 2) Dress and Suppress. Mr Matija Krkovic will explain to you which treatment option is likely to be of greatest benefit to you, taking in to account your personal health and considerations.
Debridement of the Bone
Debridement of the bone is where we aim to remove infected parts of bone to achieve permanent remission of symptoms. In different stages of disease or different levels of infections the debridement can vary significantly - anywhere from removal of a small piece of dead bone (so called “sequestrum” ) to removal a significant length of bone (segmental bone resection). If we are removing a smaller section of bone skeletal stability is not usually affected, whereas if removing larger sections of bone skeletal stability may be impaired. This means without any additional support to the bone, you won’t be able to walk on the affected limb.How the bone will be restored to its previous function will be discussed during the preoperative appointment with Mr Matija Krkovic.
Dress and Suppress
Dress and suppress is where actually having a surgery would not be the best decision for the patient, as the negative impact on the overall health would be greater than the possible benefit. In this case you would be explained the situation and suggested a specific antibiotic treatment. This is usually a long term treatment with regular monitoring. If you have a sinus present which is draining fluid in the limb, we will allow it to continue to do so. You will be explained that whilst it keeps draining the condition is under control. As soon as the sinus closes down you will be asked to be very careful and observant and to seek urgent medical attention at the earliest sign of an infection (i.e. increased pain, temperature, malaise etc).
Before any surgery you will be explained thoroughly what is going to happen, to what extent your limb stability and function will be affected, if you will need any additional procedures (i.e. plastic surgical procedures to restore soft tissue on your limb) and estimated time until the end of the treatment including all expected complications. You will be informed by Mr Krkovic as well as the Infectious Disease specialists about antibiotics including which antibiotic is required and the reasons for the treatment.
Osteomyelitis is a complex and serious infection, and recovery can vary patient by patient. Generally speaking, the sooner we approach the infection with an appropriate treatment the faster we can expect recovery. However, it is worthwhile being aware of the fact that many patients may experience reoccurrences of infection in the future, despite successful treatment.