Chronic Osteomyelitis

Infection of the bone, osteomyelitis, may occur after injury, surgery or if infection has spread from another part of the body

Dynamic 3D X-ray image showcasing the ankle joint with a vivid color scheme highlighting the pain area. Perfect for medical, healthcare, and anatomy-related visuals.
Info for Patients

Chronic Osteomyelitis (persistent bone infection)

Osteomyelitis can be caused by bacterial or fungal infection and people with problems such as diabetes or after an organ transplant are at higher risk of developing infection.

Different bones around the body may be affected, including the vertebra in your spine, bones in the legs and the base of the skull. Complications of osteomyelitis can include pain, deformity and bone destruction. Chronic osteomyelitis, infection that is persisting over the longer term, can also make a person feel generally unwell.

The mainstay of treatment of osteomyelitis initially is antibiotics. Sometimes surgery is needed, for instance to remove metalwork present which may be harbouring the infection.

If the infection continues to persist after these measures, hyperbaric oxygen (HBO) may be helpful. Some bacteria cannot live in high oxygen conditions so the HBO helps fight the infection alongside the antibiotics. It can also help increase the effectiveness of the antibiotic that you are taking.

Info for Professionals

Osteomyelitis (Refractory and including malignant otitis externa)

Hyperbaric oxygen (HBO) can be considered for osteomyelitis that persists or recurs after appropriate interventions have been performed or where acute osteomyelitis has not responded to accepted management techniques. This also includes individuals who have failed to respond to definitive surgical debridement (if possible) and four to six weeks of appropriate antibiotic therapy. Those with malignant otitis externa fall within this category.

Studies have shown that HBO can have several benefits in the repair of diseased bone:

  • Increased leukocyte oxidative killing (Esterhai 1986)
  • Increased phagocytic activity (Mader 1980)
  • Improved penetration of certain antibiotics into tissues due to oxygen dependent mechanisms. In particular, it is helpful for aminoglycosides and cephalosporins (Mendel 1999).
  • Enhanced osteogenesis by improving osteoclast function. (Ueng 1998)

Individuals felt to be most suitable are those who have failed with conventional treatment and /or have a Cierny-Madar stage 3B or 4B. Those with high risk, such as spinal, skull or sternal osteomyelitis, are likely to be considered at a lower stage.

Treatment entails 20-40 HBOT daily session over 4-8 weeks. Response is considered and this is as an adjunct to gold standard treatment.

Further information regarding the Referral and Funding process can be found here.

 

References

Esterhai JL Jr, Clark JM, Morton HE, Smith DW, Steinbach A, Richter SD. Effect of hyperbaric oxygen exposure on oxygen tension within the medullary canal in the rabbit tibial osteomyelitis model. J Orthop Res. 1986;4(3):330-6. doi: 10.1002/jor.1100040309. PMID: 3734939.

Niinikoski J, Hunt TK. Oxygen tensions in healing bone. Surg Gynecol Obstet. 1972 May;134(5):746-50. PMID: 5031484.

Mader JT, Brown GL, Guckian JC, Wells CH, Reinarz JA. A mechanism for the amelioration by hyperbaric oxygen of experimental staphylococcal osteomyelitis in rabbits. J Infect Dis. 1980 Dec;142(6):915-22. doi: 10.1093/infdis/142.6.915. PMID: 7462700.

Mathieu D, Marroni A, Kot J. Tenth European Consensus Conference on Hyperbaric Medicine: recommendations for accepted and non-accepted clinical indications and practice of hyperbaric oxygen treatment. Diving Hyperb Med. 2017 Mar;47(1):24-32. doi: 10.28920/dhm47.1.24-32. Erratum in: Diving Hyperb Med. 2017 Jun;47(2):131-132. doi: 10.28920/dhm47.2.131-132. PMID: 28357821; PMCID: PMC6147240.

Mendel V, Reichert B, Simanowski HJ, Scholz HC. Therapy with hyperbaric oxygen and cefazolin for experimental osteomyelitis due to Staphylococcus aureus in rats. Undersea Hyperb Med. 1999 Fall;26(3):169-74. PMID: 10485518.

Tisch M, Maier H. Otitis externa necroticans [Malignant external otitis]. Laryngorhinootologie. 2006 Oct;85(10):763-9; quiz 770-3. German. doi: 10.1055/s-2006-925441. PMID: 17031764.

Ueng SW, Lee SS, Lin SS, Wang CR, Liu SJ, Yang HF, Tai CL, Shih CH. Bone healing of tibial lengthening is enhanced by hyperbaric oxygen therapy: a study of bone mineral density and torsional strength on rabbits. J Trauma. 1998 Apr;44(4):676-81. doi: 10.1097/00005373-199804000-00020. PMID: 9555841.

Emergency