Treatment of Chronic Osteomyelitis with Antibiotic-impregnated Polymethyl Methacrylate (PMMA) – The Cierny Approach: Is the Second Stage Necessary

Background:
Chronic osteomyelitis is a challenge for orthopedic surgeons. Most patients with osteomyelitis receive two-stage management according to Cierny-Mader. The first stage includes radical debridement and insertion of an antibiotic-impregnated cement spacer (ACS) (beads, rods, nails, or blocks) into the bone defect. The second stage is performed 6-8 weeks later, when the spacer is removed and a cancellous autograft is placed within the bone defect. The possibility of ACS as definitive management for osteomyelitis, avoiding the second stage, is presented.

Methods:
Fifteen patients with osteomyelitis received radical debridement and insertion of an ACS in all forms into the bone defect as a definitive management. The mean follow-up period was 6 years (1.5-16 years).

Results:
No patient exhibited radiographic evidence of excessive bone loss. Signs of recurrence of osteomyelitis were not noted in any of the patients, and no fractures had occurred by the last follow-up.

Conclusion:
Our study suggests that a proportion of patients with planned retention of ACS appear to function well without requiring further surgical intervention, especially in elderly or vulnerable patients.