Time to first negative culture following debridement reaming and irrigation for chronic osteomyelitis: A look at the Lautenbach method

Abstract

Background: Chronic osteomyelitis poses a challenge for the patient and the treating surgeon. Lautenbach described an adjuvant method entailing the insertion of a double-lumen tube system, for local antibiotic delivery and dead space management.

Objective: The aim of the study was to establish the time it takes to achieve the first negative culture after the Lautenbach procedure for the treatment of chronic osteomyelitis.

Methods: We undertook a retrospective record review of patients who underwent the Lautenbach procedure from 2018 to 2021. The primary outcome was time to the first negative, fluid or tissue, culture after the procedure. Secondary outcomes were, time to 3rd negative culture, wound/sinus status, pain Visual Analogue Scale (VAS), recurrence rate and prevalence of Methicillin Resistant Staphylococcus Aureus (MRSA).

Results: Thirty eight patients were included, 27 (71.1%) males and 11 (28.9%) females. The median age was 32 years. The median time to the first negative culture was 6 days while that for the time to the 3rd negative culture result was 8 days. The median pain VAS was 3 points and the recurrence rate was 24%. There was a 10.5% rate of MRSA.

Conclusion: The Lautenbach procedure is still an effective option. However, the recurrence rate remains relatively high with majority of the patients achieving symptom resolution (pain and draining sinus). Treating surgeons should still be vigilant of MRSA and its treatment thereof.