Prognosis for Bone Infection After Surgery

Bone infection, or osteomyelitis, affects 2 in 10,000 Americans. It typically starts in the spongy medullary or inner part of the bone after having spread there from some other site in the body via the bloodstream. Often, the bone is vulnerable to infection because of trauma such as a fracture or surgery. It occurs most often in children or in adults older than 50, and it affects more men than women. The outcome of osteomyelitis depends on many factors, including the patient's general health and the type of infection.

Risk Factors

• Risk factors for developing a bone infection after surgery include diabetes, hemodialysis, poor blood circulation or supply, and intravenous (IV) drug use, according to Medline Plus. Individuals at risk for infection also include those who have had their spleen removed, those with poor nutrition, elderly adults, obese individuals, and individuals with compromised immune systems because of disease or certain drug treatments. Individuals with these types of conditions often have a poorer prognosis as well, as they don't tend to heal as quickly or as well, and the infection can go from an acute case to a difficult-to-treat, chronic one.

Features

• The symptoms of a bone infection include fever, bone pain, aches, nausea and pains that may be mistaken for the flu, swelling, redness and warmth. Sometimes there may be chills, profuse sweating and lower back pain, according to Medline Plus. After surgery, these symptoms might be erroneously attributed to the surgery itself or possibly a general infection. The longer the infection goes undiagnosed the more serious it can become.

Diagnosis

• Once a bone infection is suspected, tests must be run to confirm the diagnosis. Blood work will be performed including cultures, a complete blood count (CBC), erythrocyte sedimentation rate (ESR) and C-reactive protein level (CRP). The CBC will demonstrate an elevated white blood cell count with infection, and the ESR will be elevated because of inflammation. The CRP will indicate infection and inflammation. X-rays are able to detect osteomyelitis only when it is advanced, but bone scans performed with dye injected into the bone can reveal even the early stages of infection. However, the main diagnostic tool is bone biopsy done either through surgery or deep needle aspiration.

Treatment

• Treating a bone infection or osteomyelitis depends on the type of infection. For instance, chronic osteomyelitis requires surgery and antibiotics, whereas the acute type may be treated with antibiotics alone, according to the University of Maryland Medical Center. Often, the antibiotics are delivered through IV lines into the bloodstream and may be given for 4 to 6 weeks or sometimes longer. Surgery is done to remove dead bone tissue and may require filling the empty bone space with antibiotic-containing, cement-type material, according to the Sinai Hospital of Baltimore. If the infection is near a prosthesis or metal rod, those may need to be removed to stop the infection. Bone infections can be tricky to treat and until recently, they were actually considered incurable. That is not true and not accepted to be medical fact; however, the chronic bone infection can be difficult to treat and still at times may have such a grim prognosis as to require amputation.

Prognosis

• For bone infection after orthopedic surgery, the prognosis is quite good, near 97 percent, according to the Sinai Hospital of Baltimore. For those with immune function impairments, the prognosis is not as good. According to the National Institutes of Health, the prognosis is typically good for osteomyelitis once treated. For those with chronic or long-term bone infection, the outlook isn't as good, especially if the patient has diabetes or poor blood circulation. In these cases, it may take a long time to treat and may include multiple treatment methods. In some serious cases, amputation may be necessary to stop the infection from spreading and causing more damage or even death. Cases involving vertebrae can cause nerve damage. Chronic bone infection can lead to skin cancer or gangrene.