Role Of Prostaglandins And Ultrasound Debridement In Healing Of Septic Ulcers And Fistula – Complication Of Prostheses In Osteomyelitis Infected Knee

Erminia Bentivegna, Luigi Donato, Concetta Scimone, Vivaldi Roberto, Mularo Salvatore, Citarrella Emanuele, Mavaro Giuseppe, Rosalia D’Angelo, Antonina Sidoti

Abstract

Implant of devices in patients affected by serious osteoporosis following chronical inflammatory diseases like rheumatoid arthritis represent a great clinic and surgical challenge, especially when associated with bacterial infections. Here we report a case of a 75 years old woman who developed recidivism of infection, after prosthesis’ implantation. Although repeated treatments with both topical antibiotics and systemic ones, knee edema and purulent secretion were constant.Conventional treatment based on topical and systemic antibiotics’ administration was replaced with a vascular rehabilitative medical therapy. Furthermore, the patient has undergone surgery for ulcers and fistulas debridement at the knee, the lower third of thigh and the upper third of leg. The analyzed case suggested that the experimental protocol we used to treat implant – derived osteomyelitis with cutaneous fistulization could reduce the healing time between the primary lesion and osteomyelitis complication, but only if patient presents an acceptable condition of his immune system.

References

1.         Springer BD, Cahue S, Etkin CD, Lewallen DG, McGrory BJ: Infection burden in total hip and knee arthroplasties: an international registry-based perspective. Arthroplast Today 2017, 3:137-140.

2.         Geurts J, Hohnen A, Vranken T, Moh P: Treatment strategies for chronic osteomyelitis in low and middle income countries: Systematic review. Trop Med Int Health 2017.

3.         Jaramillo D, Dormans JP, Delgado J, Laor T, St Geme JW, 3rd: Hematogenous Osteomyelitis in Infants and Children: Imaging of a Changing Disease. Radiology 2017, 283:629-643.

4.         Lalikian K, Parsiani R, Won R, Chang E, Turner RB: Ceftaroline for the treatment of osteomyelitis caused by methicillin-resistant Staphylococcus aureus: a case series. J Chemother 2017:1-5.

5.         Ata Y, Inaba Y, Choe H, Kobayashi N, Machida J, Nakamura N, Saito T: Bone metabolism and inflammatory characteristics in 14 cases of chronic nonbacterial osteomyelitis. Pediatr Rheumatol Online J 2017, 15:56.

6.         Zimmerli W, Sendi P: Orthopaedic biofilm infections. APMIS 2017, 125:353-364.

7.         Iliadis AD, Ramachandran M: Paediatric bone and joint infection. EFORT Open Rev 2017, 2:7-12.

8.         Kim BK, Dan J, Lee YS, Kim SH, Cha YS: Salmonella osteomyelitis of the femoral diaphysis in a healthy individual. Am J Orthop (Belle Mead NJ) 2014, 43:E237-239.

9.         Rowson C, Townsend R: Biofilms: prevention and treatment. Br J Hosp Med (Lond) 2016, 77:699-703.

10.       Bentivegna E, Citarrella E, Vivaldi R, De Luca D, Maira GG, Casuccio A, Di Carlo P: Leg ulcer and osteomyelitis due to methicillin-susceptible Staphylococcus aureus infection after fracture repair treatment: a case highlighting the potential role of prostaglandin E(1) vasodilator. Infez Med 2015, 23:69-73.

11.       Johansen LK, Iburg TM, Nielsen OL, Leifsson PS, Dahl-Petersen K, Koch J, Frees D, Aalbaek B, Heegaard PM, Jensen HE: Local osteogenic expression of cyclooxygenase-2 and systemic response in porcine models of osteomyelitis. Prostaglandins Other Lipid Mediat 2012, 97:103-108.

12.       Hall JA, Beuerlein MJ, McKee MD, Canadian Orthopaedic Trauma S: Open reduction and internal fixation compared with circular fixator application for bicondylar tibial plateau fractures. Surgical technique. J Bone Joint Surg Am 2009, 91 Suppl 2 Pt 1:74-88.

13.       Govaert GA, Glaudemans AW, Ploegmakers JJ, Viddeleer AR, Wendt KW, Reininga IH: Diagnostic strategies for posttraumatic osteomyelitis: a survey amongst Dutch medical specialists demonstrates the need for a consensus protocol. Eur J Trauma Emerg Surg 2017.

14.       Wagner JM, Jaurich H, Wallner C, Abraham S, Becerikli M, Dadras M, Harati K, Duhan V, Khairnar V, Lehnhardt M, Behr B: Diminished bone regeneration after debridement of posttraumatic osteomyelitis is accompanied by altered cytokine levels, elevated B cell activity, and increased osteoclast activity. J Orthop Res 2017.

15.       Diniz MC, Olivon VC, Tavares LD, Simplicio JA, Gonzaga NA, de Souza DG, Bendhack LM, Tirapelli CR, Bonaventura D: Mechanisms underlying sodium nitroprusside-induced tolerance in the mouse aorta: Role of ROS and cyclooxygenase-derived prostanoids. Life Sci 2017, 176:26-34.

16.       Lovati AB, Romano CL, Monti L, Vassena C, Previdi S, Drago L: Does PGE(1) vasodilator prevent orthopaedic implant-related infection in diabetes? Preliminary results in a mouse model. PLoS One 2014, 9:e94758.

17.       Lironi C, McLin VA, Wildhaber BE: The Effect and Safety of Prostaglandin Administration in Pediatric Liver Transplantation. Transplant Direct 2017, 3:e163.