Functional outcome of chronic osteomyelitis treated by sequestrectomy & saucerisation with antibiotic bead implantation

Chronic Osteomyelitis has been treated since inception of Orthopaedics, however a ideal treatment eliminating the disease doesn’t exist. Numerous treatment modalities & Surgical procedures have been tried with varied results, owing to the chronic nature of the infection, virulence of organism and complex pathogenesis. With time, the antibiotic delivery to target site has expanded to include effective oral agents and local therapy with antibiotics mixed in bone cement or use of biodegradable antibiotic impregnated materials. This study intends to obtain factors which influence the incidence of osteomyelitis in the population & also to know the common means of transmission of bony infection, further identification of the major areas of disease manifestations and means of eradication of the same by our procedure. We conducted a prospective randomized control study on patients diagnosed with chronic osteomyelitis in the age group of 4- 60 years. 30 patients were treated with sequestrectomy and saucerisation & dead space filling with biodegradable antibiotic impregnated calcium sulphate beads for local delivery of antibiotics. The calcium sulfate used in this study was The STIMULAN KIT. This bone void filler kit consists of surgical-grade calcium sulfate powder and a sodium chloride diluent with Vancomycin as the broad spectrum antibiotic.: Functional outcome was evaluated using Enneking Functional Evaluation System which is a 30 point system for both upper and lower limbs. X-rays were used to evaluate the dead space volume (in cc) and bone repair (in %). Each patients were followed up for minimum of six months. The mean score for functional outcome was found to be 29.93. In 18 patients osteomyelitis occurred by hematogenous spread (60%) by superficial skin infection, Mean age of 13 patients (43.3%) were in the age group of 4-10 years. 63.3% of affected individuals were male. Most common site of infection was found to be tibia (33.3%) & most of the culture report from infection site showed no growth(90%). Complications such as prolonged ooze was seen in 15.9% cases. On Statistical analysis of the functional outcome, p value was found to be significant < 0.001.Antibiotics containing beads (Stimulan Kit) is effective in the treatment of chronic osteomyelitis and in preventing the recurrence of infection. It is imperative to identify various factors responsible for the recurrence of infection. This may help clinicians predict the prognosis of the disease and minimise the risk of adverse outcomes.