The Social Impact Associated with Chronic Osteomyelitis. A Grading System for the Most Frequent Complication

Abstract

Introduction: The psychosocial complications from chronic osteomyelitis are frequent and sometimes devastating. Our objective was to define and grade the impact of chronic osteomyelitis on the patient's quality of life.
Patients and Methods: Thirty-six adult patients with active chronic osteomyelitis were interviewed to identify and rank the social trigger factors affecting the patient's quality of life. A grading system from I to III is proposed.
Results: Loss of working ability, medical coverage and spouses were the three major trigger points for a long cascade of adverse events in 33 (94 %) of the patients. The patients were classified as grade I if they were still employed, grade II if they lost also their medical coverage and grade III if they had also lost family support.
Discussion and Conclusion: All efforts should be directed to keep the patient on a grade I. The progression from grade I to grade III was significantly affected by the number of surgical procedures or unsuccessful antibiotic treatments. The greatest challenge in the treatment of osteomyelitis is to prevent the social deterioration that accompanies and is the hallmark of this disease by an early and effective treatment.

Chronic osteomyelitis - complications - bone infections - psychosocial

References

• 1 Alabi Z O, Ojo O S, Odesanmi W O. Secondary amyloidosis in chronic osteomyelitis.  Int Orthop. 1991;  15 21-22
• 2 Cheatle M D. The effect of chronic orthopedic infection on quality of life.  Orthop Clin North Am. 1991;  22 539-547
• 3 Cierny G, Mader J T, Penning J J. A clinical staging system for chronic osteomyelitis.  Clin Orthop. 2003;  414 7-24
• 4 Gebhart M, Fabeck L, Muller C. Malignant transformation of chronic osteomyelitis and its scar tissue: apropos of 3 cases.  Acta Orthop Belg. 1993;  59 327-332
• 5 Heitemeyer U, Hax P M. Economic aspects of bone infection.  Aktuelle Probl Chir Orthop. 1990;  34 162-164
• 6 Hoffmann F, Hoffmann U, Senst W. Psychosocial problems in patients with chronic osteomyelitis.  Zentralbl Chir. 1991;  116 177-184
• 7 Jenny G. Psychic hospitalism in patients confined to bed for long periods of time in the septic ward for posttraumatic osteomyelitis.  Z Plast Chir. 1980;  4 234-238
• 8 Klemm K. The social environment and consequences in patients with posttraumatic osteomyelitis.  Langenbecks Arch Chir. 1986;  369 717-719
• 9 Kyle R A, Bayrd E D. Amyloidosis: review of 236 cases.  Medicine (Baltimore). 1975;  54 271-299
• 10 Lerner R K, Esterhai J L, Polomano R C, Cheatle M D, Heppenstall R B. Quality of life assessment of patients with posttraumatic fracture nonunion, chronic refractory osteomyelitis, and lower-extremity amputation.  Clin Orthop. 1993;  295 28-36
• 11 Lerner R K, Esterhai J L, Polomono R C, Cheatle M C, Heppenstall R B, Brighton C T. Psychosocial, functional, and quality of life assessment of patients with posttraumatic fracture nonunion, chronic refractory osteomyelitis, and lower extremity amputation.  Arch Phys Med Rehabil. 1991;  72 122-126
• 12 McGrory J E, Pritchard D J, Unni K K, Ilstrup D, Rowland C M. Malignant lesions arising in chronic osteomyelitis.  Clin Orthop. 1999;  362 181-189
• 13 Patetsios P, George M, Ghosh B C. Squamous-cell carcinoma from chronic osteomyelitis.  J Am Coll Surg. 2000;  191 217
• 14 Puri A, Parasnis A S, Udupa K V, Duggal A, Agarwal M G. Fibroblastic osteosarcoma arising in chronic osteomyelitis.  Clin Radiol. 2003;  58 170-172
• 15 Rubel I. The social cascade after chronic osteomyelitis. Proceedings 6th EFORT Annual Meeting, Helsinki, Finland 2003; 02544: 140
• 16 Seligson D, Klemm K. Adult posttraumatic osteomyelitis of the tibial diaphysis of the tibial shaft.  Clin Orthop. 1999;  360 30-36
• 17 Siegel H J, Patzakis M J, Holtom P D, Sherman R, Shepherd L. Limb salvage for chronic tibial osteomyelitis: an outcomes study.  J Trauma. 2000;  48 484-489
• 18 Stiefelhagen P. Renal failure in chronic osteomyelitis. Secondary amyloidosis in chronic osteomyelitis.  MMW Fortschr Med. 2000;  142 45-46
• 19 Uber K. Scientific, social and psychologic aspects of post-traumatic bone infections.  Hefte Unfallheilkd. 1982;  157 393-416
• 20 Weddington W W, Segraves K B, Simon M A. Psychological outcome of extremity sarcoma survivors undergoing amputation or limb salvage.  J Clin Oncol. 1985;  3 1393-1399