Prognosis
Most patients with acute osteomyelitis recover with no long-term complications if osteomyelitis is diagnosed promptly and treated adequately.
Management of osteomyelitis in dedicated units, with close multidisciplinary working, is associated with high success rates and high patient-satisfaction scores. Numerous published case series report that more than 90% of patients have infection-free limbs at 2 years or more after treatment.[91][93][99][102] These series are from centres with established multidisciplinary teams that can deliver all aspects of treatment. The prognosis from early intervention is usually better, particularly in the context of implant-related infection. Delay in treating these patients is likely to worsen long-term outcomes. The functional outcome for osteomyelitis of the lower extremity depends on the status of the foot and knee.
The success of treatment of chronic osteomyelitis depends largely on the host class (A, B, or C according to the Cierny-Mader classification; see Classification in the Aetiology section of this topic).[1] A study of 1966 patients showed that primary treatment was successful in 96% of class A hosts and 73% of class B hosts.[102] Retreatment of the patients in whom treatment had failed gave a 95% success rate at 2 years for both class A and class B patients.
Recurrence of infection may occur early or late. Early relapse is usually seen shortly after stopping antibiotics and can be treated by repeated surgery. Most patients who relapse have symptoms within the first 2 years after surgery. Although recurrence becomes less likely with the passage of time, a few patients can relapse many years later.
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