Contemporary treatment of chronic osteomyelitis: implementation in low- and middle-income countries

Aim: Chronic osteomyelitis is still a difficult problem to treat in the developed world, but even more so in low- and middle-income countries. Contemporary treatment options result in satisfying outcomes in a setting with abundant resources, but the question is whether these treatment options can be translated to other, less supported health care systems and if they obtain the same results.

Methods: Eighteen patients with established chronic osteomyelitis (eight type III, ten type IV) were prospectively enrolled and treated in a one-stage procedure with radical debridement and dead space management using bioactive glass S53P4 granules, together with adjuvant antibiotic therapy.

Results: Thirteen patients were assessed at 24 months. Infection control was achieved in five patients (38%). Eight patients (61.5%) had persistence or recurrence of infection. Loss to follow-up was substantial (five patients, 28%).

Conclusion: Due to specific challenges treating chronic osteomyelitis in low- and middle-income countries, contemporary treatment options cannot be ‘copy-pasted’ with the same results in these settings.