Pathogenetic features of chronic osteomyelitis treatment

Over the past decades, there has been a steady increase in the incidence of osteomyelitis. It is associated with an increased use of implants in traumatology and orthopedics. The social aspects of osteomyelitis are, on the one hand, significant financial costs for the healthcare system, and on the other hand, high recurrence and re-infection in the treatment of joint pathology associated with long-term loss of work ability and a high risk of patient’s disability. Purpose To conduct a search and analysis of publications in Russian and English, devoted to the problem of osteomyelitis and periprosthetic infection, on the basis of which to summarize the main current notions about the etiology, pathogenesis, diagnosis and treatment of osteomyelitis. Materials and methods The search was carried out in the Pubmed and CyberLeninka databases of literature sources over the past 10 years. The data were analyzed and compared with the materials from earlier publications. Only publications from peer-reviewed journals were considered for analysis. Results and discussion Success in the treatment of peri-implant infection with prosthesis re-implantation and satisfactory joint function has been achieved in only just more than a half of patients. Recent studies have significantly changed the understanding of the etiology and pathogenesis of osteomyelitis. It has been proven that in osteomyelitis and implant-associated infection, four reservoirs of infection are formed in the patient's body: abscesses in soft tissues and bone marrow canal, biofilms on the surface of implants and necrotic tissues, intracellular colonization with bacteria of the macroorganism and lacunar-canalicular system. Understanding the mechanisms of osteomyelitis development and its course forces the specialists to take a fresh look at the causes of failures in the fight against such a severe pathology and change approaches to its prevention, diagnosis and treatment.