A Modified Management of Implant Associated Postoperative Osteomyelitis With Cierny-Mader Type

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Abstract

Abstract Background: No standardized protocol has been suggested in the treatment of postoperative osteomyelitis. Our team evaluates the clinical efficacy of the modified tactics of implant associated postoperative osteomyelitis patients according to Cierny-Mader type. Methods: 95wounds were reviewed from March 2009 to February 2016 in our hospital. 61 wounds were treated by the modified algorithm as following: Stable hardware + bone not healed Cierny–Mader 1 type = remove hardware, temporary stabilize; Stable hardware + bone not healed Cierny–Mader 2 type = retain hardware ; Stable hardware + bone not healed Cierny–Mader for type 3 and type 4 = remove hardware, temporary stabilize/ Ilizarov technique; Unstable hardware + bone not healed = remove hardware, temporary stabilize/ Ilizarov technique; Stable hardware + bone healed = remove hardware. 34 wounds were treated by the conventional algorithm. Autodermoplasty, flap transfer, myocutaneous flap and other methods including antibiotic irrigation and drug delivery system were used in wound repair. Results: The patients treated with modified algorithm had a significantly reduced recurrence (P＜0.01) , and increased results of negative bacterial cultures (P＜0.01), but however observed a decrease in the number of retained hardware cases (P＜0.05) . For those treated with tissue reconstruction, there was no significantly (P＞0.05) comparing with the conventional group. Conclusions: The modified technique for the implant associated postoperative osteomyelitis according to the stability of the hardware and Cierny-Mader type represent a good clinical efficacy in the management of postoperative osteomyelitis. This procedure is simple and shows promising results, more clinical evidence is needed to confirm the existing findings and optimize the treatment of postoperative osteomyelitis. Key Words: Osteomyelitis, Postoperation, Implant