Two-stage surgery for adult patients with chronic hematogenous osteomyelitis of the femur or tibia: A case series study

Background: To evaluate the clinical efficacy and feasibility of a two-stage surgery using the induced membrane technique combined with antibiotic-loaded bone cement sustained-release for patients with chronic hematogenous osteomyelitis (CHOM) of the femur or tibia. Methods In this case series study, data of patients with CHOM underwent the two-stage surgery in our Hospital between January 2016 and June 2019 were retrospectively analyzed. Results A total of 18 patients (16 men) with an average age of 32.1 (range from 16 to 56) years old were included. The average duration of disease was 17.8 (range from 1.2 to 42) years. The infection was located in tibia in 10 cases and femur in 8 cases. Besides, 10 cases had sinus tract or local redness, swelling, as well as fever of the affected limbs preoperatively. After the surgery, all patients were followed up for 29.1 (range from 22 to 47) months. At the end of follow-up, no recurrence of infection, swelling and pus was found. The white blood cell count, C-reactive protein (CRP) level, and erythrocyte sedimentation rate (ESR) were all returned to normal ranges. Conclusions The two-stage surgery using the induced membrane technique combined with antibiotic-loaded bone cement sustained-release might be a feasible and effective treatment for adult patients with CHOM.