Download PDF
Semin Plast Surg 2009; 23(2): 141-147
DOI: 10.1055/s-0029-1214166
© Thieme Medical Publishers

Adjunctive Therapies in the Treatment of Osteomyelitis

Robert C. Fang1 , Robert D. Galiano1
  • 1Division of Plastic and Reconstructive Surgery, Department of Surgery, Northwestern University Feinberg School of Medicine, Chicago, Illinois
Further Information

Publication History

Publication Date:
30 April 2009 (online)

    Permissions and Reprints

ABSTRACT

The current management for chronic osteomyelitis centers on adequate antibiotic coverage and surgical debridement of nonviable tissue. The eradication of osteomyelitis, however, often involves a prolonged and frustrating course of management. Nonsurgical adjunctive modalities have not been widely used, mostly due to a lack of perceived efficacy, and have remained in a state of infancy. In this article, we will outline the rationale, current status, and evidence for several potential adjuncts to osteomyelitis management.

KEYWORDS

Osteomyelitis - adjunctive therapy - hyperbaric oxygen therapy - biofilm - growth factor

REFERENCES

  • 1 Lew D P, Waldvogel F A. Osteomyelitis.  Lancet. 2004;  364 369-379
    CrossrefPubMedGoogle Scholar
  • 2 Parsons B, Strauss E. Surgical management of chronic osteomyelitis.  Am J Surg. 2004;  188(Suppl) 57-66
    PubMedGoogle Scholar
  • 3 Tice A D, Hoaglund P A, Shoultz D A. Outcomes of osteomyelitis among patients treated with outpatient parenteral antimicrobial therapy.  Am J Med. 2003;  114 723-728
    CrossrefPubMedGoogle Scholar
  • 4 Lipsky B A, Berendt A R, Deery H G et al.. Diagnosis and treatment of diabetic foot infections.  Plast Reconstr Surg. 2006;  117(7, Suppl) 212S-238S
    CrossrefPubMedGoogle Scholar
  • 5 Lavery L A, Armstrong D G, Wunderlich R P, Mohler M J, Wendel C S, Lipsky B A. Risk factors for foot infections in individuals with diabetes.  Diabetes Care. 2006;  29 1288-1293
    Google Scholar
  • 6 Chen C E, Shih S T, Fu T H, Wang J W, Wang C J. Hyperbaric oxygen therapy in the treatment of chronic refractory osteomyelitis: a preliminary report.  Chang Gung Med J. 2003;  26 114-121
    PubMedGoogle Scholar
  • 7 Chen C E, Ko J Y, Fu T H, Wang C J. Results of chronic osteomyelitis of the femur treated with hyperbaric oxygen: a preliminary report.  Chang Gung Med J. 2004;  27 91-97
    PubMedGoogle Scholar
  • 8 Gill A L, Bell C NA. Hyperbaric oxygen: its uses, mechanisms of action, and outcomes.  QJM. 2004;  97 385-395
    CrossrefPubMedGoogle Scholar
  • 9 Kawashima M, Tamura H, Nagayoshi I, Takao K, Yoshida K, Yamaguchi T. Hyperbaric oxygen therapy in orthopedic conditions.  Undersea Hyperb Med. 2004;  31 155-162
    PubMedGoogle Scholar
  • 10 Chen X, Kidder L S, Lew W D. Osteogenic protein-1 induced bone formation in an infected segmental defect in the rat femur.  J Orthop Res. 2002;  20 142-150
    CrossrefPubMedGoogle Scholar
  • 11 Chen X, Schmidt A H, Tsukayama D T, Bourgeault C A, Lew W D. Recombinant human osteogenic protein-1 induces bone formation in a chronically infected, internally stabilized segmental defect in the rat femur.  J Bone Joint Surg Am. 2006;  88 1510-1523
    CrossrefPubMedGoogle Scholar
  • 12 Ross J J. Angiogenic gene therapy as a potential therapeutic agent in chronic osteomyelitis.  Med Hypotheses. 2006;  67 161-163
    CrossrefPubMedGoogle Scholar
  • 13 Southwood L L, Frisbie D D, Kawcak C E, Ghivizzani S C, Evans C H, McIlwraith C W. Evaluation of Ad-BMP-2 for enhancing fracture healing in an infected defect fracture rabbit model.  J Orthop Res. 2004;  22 66-72
    CrossrefPubMedGoogle Scholar
  • 14 Costerton J W. Biofilm theory can guide the treatment of device-related orthopaedic infections.  Clin Orthop Relat Res. 2005;  437 7-11
    PubMedGoogle Scholar
  • 15 Calhoun J H, Manring M M. Adult osteomyelitis.  Infect Dis Clin North Am. 2005;  19 765-786
    CrossrefPubMedGoogle Scholar
  • 16 Vercillo M, Patzakis M J, Holtom P, Zalavras C G. Linezolid in the treatment of implant-related chronic osteomyelitis.  Clin Orthop Relat Res. 2007;  461 40-43
    PubMedGoogle Scholar
  • 17 Mader J T, Guckian J C, Glass D L, Reinarz J A. Therapy with hyperbaric oxygen for experimental osteomyelitis due to Staphylococcus aureus in rabbits.  J Infect Dis. 1978;  138 312-318
    PubMedGoogle Scholar
  • 18 Mader J T, Brown G L, Guckian J C, Wells C H, Reinarz J A. A mechanism for the amelioration by hyperbaric oxygen of experimental staphylococcal osteomyelitis in rabbits.  J Infect Dis. 1980;  142 915-922
    PubMedGoogle Scholar
  • 19 Mandell G L. Bactericidal activity of aerobic and anaerobic polymorphonuclear neutrophils.  Infect Immun. 1974;  9 337-341
    PubMedGoogle Scholar
  • 20 Barth E, Sullivan T, Berg E. Animal model for evaluating bone repair with and without adjunctive hyperbaric oxygen therapy (HBO): comparing dose schedules.  J Invest Surg. 1990;  3 387-392
    CrossrefPubMedGoogle Scholar
  • 21 Hunt T K, Pai M P. The effect of varying ambient oxygen tensions on wound metabolism and collagen synthesis.  Surg Gynecol Obstet. 1972;  135 561-567
    PubMedGoogle Scholar
  • 22 Knighton D R, Silver I A, Hunt T K. Regulation of wound-healing angiogenesis-effect of oxygen gradients and inspired oxygen concentration.  Surgery. 1981;  90 262-270
    PubMedGoogle Scholar
  • 23 Park M K, Myers R A, Marzella L. Oxygen tensions and infections: modulation of microbial growth, activity of antimicrobial agents, and immunologic responses.  Clin Infect Dis. 1992;  14 720-740
    CrossrefPubMedGoogle Scholar
  • 24 Verklin Jr R M, Mandell G L. Alteration of effectiveness of antibiotics by anaerobiosis.  J Lab Clin Med. 1977;  89 65-71
    PubMedGoogle Scholar
  • 25 Bennett M H, Stanford R, Turner R. Hyperbaric oxygen therapy for promoting fracture healing and treating fracture non-union.  Cochrane Database Syst Rev. 2005;  (1) CD004712
    PubMedGoogle Scholar
  • 26 Wang C, Schwaitzberg S, Berliner E, Zarin D A, Lau J. Hyperbaric oxygen for treating wounds: a systematic review of the literature.  Arch Surg. 2003;  138 272-279
    CrossrefPubMedGoogle Scholar
  • 27 Davis J C, Heckman J D, DeLee J C, Buckwold F J. Chronic non-hematogenous osteomyelitis treated with adjuvant hyperbaric oxygen.  J Bone Joint Surg Am. 1986;  68 1210-1217
    PubMedGoogle Scholar
  • 28 Esterhai Jr J L, Pisarello J, Brighton C T, Heppenstall R B, Gellman H, Goldstein G. Adjunctive hyperbaric oxygen therapy in the treatment of chronic refractory osteomyelitis.  J Trauma. 1987;  27 763-768
    PubMedGoogle Scholar
  • 29 Centers for Medicare and Medicaid Services .Medicare National Coverage Determinations Manual. 2007 Internet-only manual # 100-03 http://www.cms.hhs.gov/manuals/10m
    Google Scholar
  • 30 Lentrodt S, Lentrodt J, Kubler N, Modder U. Hyperbaric oxygen for adjuvant therapy for chronically recurrent mandibular osteomyelitis in childhood and adolescence.  J Oral Maxillofac Surg. 2007;  65 186-191
    CrossrefPubMedGoogle Scholar
  • 31 Esterhai Jr J L, Pisarello J, Brighton C T, Heppenstall R B, Gellman H, Goldstein G. Adjunctive hyperbaric oxygen therapy in the treatment of chronic refractory osteomyelitis.  J Trauma. 1987;  27 763-768
    PubMedGoogle Scholar
  • 32 Southwood L L, Frisbie D D, Kawcak C E, Ghivizzani S C, Evans C H, McIlwraith C W. Evaluation of Ad-BMP-2 for enhancing fracture healing in an infected defect fracture rabbit model.  J Orthop Res. 2004;  22 66-72
    CrossrefPubMedGoogle Scholar
  • 33 Costerton J W, Stewart P S, Greenberg E P. Bacterial biofilms: a common cause of persistent infections.  Science. 1999;  284 1318-1322
    CrossrefPubMedGoogle Scholar
  • 34 Gristina A G, Oga M, Webb L X, Hobgood C D. Adherent bacterial colonization in the pathogenesis of osteomyelitis.  Science. 1985;  228 990-993
    PubMedGoogle Scholar
  • 35 Mayberry-Carson K J, Tober-Meyer B, Smith J K, Lambe Jr D W, Costerton J W. Bacterial adherence and glycocalyx formation in osteomyelitis experimentally induced with Staphylococcus aureus.  Infect Immun. 1984;  43 825-833
    PubMedGoogle Scholar
  • 36 Monzon M, Garcia-Alvarez F, Lacleriga A et al.. A simple infection model using pre-colonized implants to reproduce rat chronic Staphylococcus aureus osteomyelitis and study antibiotic treatment.  J Orthop Res. 2001;  19 820-826
    CrossrefPubMedGoogle Scholar
  • 37 Dell'Acqua G, Giacometti A, Cirioni O et al.. Suppression of drug-resistant Staphylococcal infections by the quorum-sensing inhibitor RNAIII-inhibiting peptide.  J Infect Dis. 2004;  190 318-320
    CrossrefPubMedGoogle Scholar
  • 38 Cirioni O, Giacometti A, Ghiselli R et al.. Prophylactic efficacy of topical temporin A and RNAIII-inhibiting peptide in a subcutaneous rat pouch model of graft infection attributable to staphylococci with intermediate resistance to glycopeptides.  Circulation. 2003;  108 767-771
    CrossrefPubMedGoogle Scholar
  • 39 Balaban N, Collins L V, Cullor J S et al.. Prevention of diseases caused by Staphylococcus aureus using the peptide RIP.  Peptides. 2000;  21 1301-1311
    CrossrefPubMedGoogle Scholar
  • 40 Nelson F R, Brighton C T, Ryaby J et al.. Use of physical forces in bone healing.  J Am Acad Orthop Surg. 2003;  11 344-354
    PubMedGoogle Scholar
  • 41 Guerkov H H, Lohmann C H, Liu Y et al.. Pulsed electromagnetic fields increase growth factor release by nonunion cells.  Clin Orthop Relat Res. 2001;  384 265-279
    CrossrefPubMedGoogle Scholar
  • 42 Nagai M, Ota M. Pulsating electromagnetic field stimulates mRNA expression of bone morphogenetic protein-2 and -4.  J Dent Res. 1994;  73 1601-1605
    PubMedGoogle Scholar
  • 43 Rubin C, Bolander M, Ryaby J P, Hadjiargyrou M. The use of low-intensity ultrasound to accelerate the healing of fractures.  J Bone Joint Surg Am. 2001;  83 259-270
    CrossrefPubMedGoogle Scholar
  • 44 Parvizi J, Wu C C, Lewallen D G, Greenleaf J F, Bolander M E. Low-intensity ultrasound stimulates proteoglycan synthesis in rat chondrocytes by increasing aggrecan gene expression.  J Orthop Res. 1999;  17 488-494
    CrossrefPubMedGoogle Scholar
  • 45 Yang K H, Parvizi J, Wang S J et al.. Exposure to low-intensity ultrasound increases aggrecan gene expression in a rat femur fracture model.  J Orthop Res. 1996;  14 802-809
    PubMedGoogle Scholar
  • 46 Rawool N M, Goldberg B B, Forsberg F, Winder A A, Hume E. Power Doppler assessment of vascular changes during fracture treatment with low-intensity ultrasound.  J Ultrasound Med. 2003;  22 145-153
    PubMedGoogle Scholar
  • 47 Ehrlich G D, Stoodley P, Kathju S et al.. Engineering approaches for the detection and control of orthopaedic biofilm infections.  Clin Orthop Relat Res. 2005;  437 59-66
    PubMedGoogle Scholar
  • 48 McLeod B R, Fortun S, Costerton J W, Stewart P S. Enhanced bacterial biofilm control using electromagnetic fields in combination with antibiotics.  Methods Enzymol. 1999;  310 656-670
    PubMedGoogle Scholar
  • 49 Eppley B L, Pietrzak W S, Blanton M. Platelet-rich plasma: a review of biology and applications in plastic surgery.  Plast Reconstr Surg. 2006;  118 147e-159e
    CrossrefPubMedGoogle Scholar
  • 50 Liu Y, Kalen A, Risto O, Wahlstrom O. Fibroblast proliferation due to exposure to a platelet concentrate in vitro is pH dependent.  Wound Repair Regen. 2002;  10 336-340
    CrossrefPubMedGoogle Scholar
  • 51 Marx R E. Platelet-rich plasma: evidence to support its use.  J Oral Maxillofac Surg. 2004;  62 489-496
    CrossrefPubMedGoogle Scholar

Robert D GalianoM.D. 

Assistant Professor of Surgery, Division of Plastic and Reconstructive Surgery, Department of Surgery

Northwestern University Feinberg School of Medicine, Galter Pavilion 19-250, 675 N. St. Clair Street, Chicago, IL 60611

Email: rgaliano@nmh.org

      >