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Localization of osteomyelitis lesions for operative eradication of chronic osteomyelitis of the lower extremities by bone SPECT/CT: a feasibility study

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Abstract

Purpose

This study was performed to investigate the feasibility of bone single-photon emission tomography/computed tomography (SPECT/CT) for pre-operative planning of chronic osteomyelitis (COM) of the lower extremities by localization of osteomyelitis lesions.

Methods

From January 2016 to January 2020, we surgically treated ten adult patients with Cierny-Mader type III COM in the tibia or femur for a mean duration of 24.4 months (range 7.0–70.0 months). We conducted pre-operative planning by bone SPECT/CT and localization of osteomyelitis lesions. The treatment consisted of intra-operative eradication of the infective focus and antibiotic administration. The clinical and radiological outcomes were retrospectively analyzed after a minimum of one year of follow-up.

Results

The patients were surgically treated by thorough debridement, dead space management, and appropriate antibiotics without bone transport or an external fixator. The location of the hot uptake region on bone SPECT/CT coincided with that of the osteomyelitis lesion, which was confirmed intra-operatively in all patients. At an average of 16.5 ± 4.3 months (range, 13.0–25.0 months), clinical eradication of osteomyelitis was achieved in nine of the ten patients. One patient required amputation due to recurrence of osteomyelitis. A successful clinical outcome was achieved in eight patients; one suffered persistent ankle pain due to a destructive change in the ankle joint despite eradication of the infection.

Conclusion

Bone SPECT/CT is a feasible method for the localization and eradication of osteomyelitis lesions in COM of the lower extremities and has favourable clinical outcomes. It can also be applied in cases of distorted bony structures caused by previous trauma or surgery, or in the presence of implants.

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Data availability

The data that support the findings of this study are available on request from the corresponding author, MB Kim. The data are not publicly available due to information that could compromise the privacy of research participants.

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Acknowledgements

We thank Textcheck (http://www.textcheck.com) for editing and reviewing the English language in this manuscript.

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Authors and Affiliations

  1. Department of Orthopaedic Surgery, Chungnam National University Sejong Hospital, Chungnam National University College of Medicine, Sejong, South Korea

    Seung Hoo Lee

  2. Department of Orthopaedic Surgery, Seoul National University Hospital, Seoul National University College of Medicine, 101 Daehak-Ro, Jongno-Gu, Seoul, 03080, South Korea

    Min Bom Kim

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Contributions

All authors fulfill authorship requirements according to ICMJE.

Each author contributed the work as follows:

Seung Hoo Lee, MD., conception of the work, the acquisition, analysis and interpretation of data for the work, and drafting the work and revising it critically for important intellectual content, final approval of the version to be published, and agreement to be accountable of all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

Min Bom Kim, MD., Ph.D., conception of the work, the acquisition, analysis and interpretation of data for the work, and drafting the work and revising it critically for important intellectual content, final approval of the version to be published, and agreement to be accountable of all aspects of the work in ensuring that questions related to the accuracy or integrity of any part of the work are appropriately investigated and resolved.

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Correspondence to Min Bom Kim.

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We obtained approval from the Seoul National University Hospital Institutional Review Board (IRB No.: H-2203–050-1303).

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Lee, S.H., Kim, M.B. Localization of osteomyelitis lesions for operative eradication of chronic osteomyelitis of the lower extremities by bone SPECT/CT: a feasibility study. International Orthopaedics (SICOT) 47, 5–15 (2023). https://doi.org/10.1007/s00264-022-05617-5

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