Osteomyelitis (Bone Infection)

Overview

Osteomyelitis is an infection of bone, most commonly caused by bacterial infection, particularly Staphylococcus aureus. It can develop acutely (over days to weeks, often following an injury or surgery) or chronically (persisting or recurring over months to years).

Chronic osteomyelitis is a complex, serious condition that requires specialist management. It often involves dead bone (sequestrum), draining sinuses, and a history of previous operations. If left untreated, it can lead to sepsis, systemic illness, and limb loss.

Prof Kevin Tetsworth is internationally recognised for managing chronic osteomyelitis. He has treated more than 2,000 cases of chronic bone infection throughout his career, employing staged surgical techniques and modern reconstruction approaches to save limbs and restore function.

When Is It Needed?

Treatment of osteomyelitis is indicated when you have:

• Persistent bone pain, redness, swelling, or warmth—especially following an injury or operation
• A draining sinus tract or non-healing wound over bone
• Fever, malaise, or blood tests showing raised inflammatory markers, with imaging confirming bone involvement
• A previous fracture, joint replacement, or amputation site that has become infected
• Bone biopsy or culture confirming bacterial infection

Early diagnosis and treatment are critical. If you suspect bone infection, seek specialist evaluation promptly.

The Procedure

Treatment of chronic osteomyelitis is staged and multidisciplinary, typically involving your surgeon, an infectious diseases specialist, and your physiotherapist:

1. Diagnosis and Staging — Advanced imaging (MRI, CT, nuclear bone scans) and tissue biopsy confirm the causative organism and assess the extent of dead bone and soft-tissue involvement. This planning is essential for surgical strategy.

2. Debridement — Surgical removal of all infected and dead bone and soft tissue. This is the single most important step and often requires multiple procedures to ensure complete removal of non-viable tissue.

3. Dead-Space Management — The bone defect left after debridement is managed using antibiotic-laden cement, bone graft, or a vascularised soft-tissue flap, depending on the size and location.

4. Stabilisation — If the bone is weakened by infection or debridement, it is stabilised using external fixation (often an Ilizarov frame) or internal fixation to allow weight-bearing and healing.

5. Targeted Antibiotics — A prolonged course of intravenous antibiotics (typically 6 weeks, sometimes longer) is guided by culture results and infectious diseases team recommendations.

6. Reconstruction — Depending on the extent of bone loss, bone transport, bone grafting, or limb lengthening may be required to restore bone continuity and function. This phase can take months to years in severe cases.

Recovery & Rehabilitation

Recovery varies greatly depending on the severity of infection, the amount of bone lost, and the reconstruction required.

• Simple acute osteomyelitis: 3–6 months with antibiotics and minor surgery
• Chronic osteomyelitis with segmental defects: 12–24 months or longer, involving multiple staged procedures

Throughout recovery, you will work closely with physiotherapists to manage weight-bearing, wound care, and progressive strength training. If external fixation (Ilizarov frame) is used, ongoing frame adjustments and care are part of the healing process.

Return to full function depends on limb reconstruction and your overall fitness.

Risks & Complications

Chronic osteomyelitis is a serious condition with potential complications:

• Recurrent infection — even after apparently successful treatment, re-activation can occur, requiring lifelong vigilance
• Non-union or malunion — bone may fail to heal or heal in an abnormal position
• Joint stiffness — especially if infection involves a joint (septic arthritis)
• Nerve or blood vessel injury — from infection or surgical intervention
• Need for further surgery — staged reconstruction often requires multiple procedures
• Amputation — in severe, refractory cases where reconstruction is not feasible or would result in worse function than prosthetic replacement

Despite these risks, modern staged surgical approaches and specialist teams have dramatically improved limb-salvage rates. Most patients can be successfully treated and return to functional lives.

Frequently Asked Questions

Can osteomyelitis be cured? Acute osteomyelitis, if treated promptly with antibiotics and minor surgery, is often cured. Chronic osteomyelitis is better understood as “controlled” rather than “cured”—long-term follow-up and vigilance for recurrence are essential throughout your life. Recurrence rates vary but are not uncommon.

Do I always need surgery? Most chronic osteomyelitis cases require surgery. Acute cases caught very early may respond to antibiotics alone. However, once dead bone forms (sequestrum), antibiotics alone cannot penetrate dead tissue effectively, and surgical debridement becomes necessary.

Will I keep my limb? Modern staged reconstruction approaches, developed over decades by specialists like Prof Tetsworth, have dramatically improved limb salvage. The vast majority of limbs can be saved. Amputation is reserved for cases in which reconstruction is not feasible or would result in worse function than prosthetic replacement—a decision made collaboratively with you.

How long will treatment take? Simple cases may be resolved in 3–6 months. Severe chronic osteomyelitis with bone loss can take 12–24 months or longer, involving multiple surgeries, prolonged antibiotics, and staged reconstruction. Your surgeon will provide a realistic timeline during your initial assessment.

What happens after treatment is complete? Lifelong follow-up is recommended. Regular reviews with your surgeon, prompt attention to any signs of recurrence (pain, swelling, discharge), and imaging as recommended will help detect recurrence early and prevent serious complications.