UKZN Orthopaedic Surgeon’s PhD Study Develops New Approach to Treatment of Chronic Osteomyelitis

BY: .

UKZN’s Department of Orthopaedic Surgery’s Dr Leonard Charles Marais has developed a novel stratification system and treatment strategy selection algorithm for the treatment of chronic osteomyelitis.

Studies emanating from his proposals following research for his PhD degree show favourable outcomes in both low and high risk cases of chronic bone infections with a concurrent reduction in the need for amputation.

His study titled:  “An Integrated Approach to Adult Chronic Osteomyelitis” investigated the short-term outcome of treatment of chronic osteomyelitis where management was based on a refined host stratification system.

‘Chronic bone infections are extremely difficult to treat, not only because of the unique characteristics of the causative organisms, but also due to the complexity of the surgery involved,’ Marais said.

He explained that the surgeon needs to consider the patient’s local and systemic capacity to eradicate infection when selecting a treatment plan, ‘In essence, there are two options: Curative treatment, which involves either complex (and risky) surgical debridement and reconstructive techniques, or palliative treatment, which is less risky and involves chronic antibiotic therapy.’

He explained further that the stakes were high and instituting curative treatment involving distraction osteogenesis, for example, in patients who are not able to meet the metabolic demand of the procedure, could result in amputation of the limb.

He said prior to his research, there was no evidence-based approach to selecting the appropriate treatment strategy. ‘By integrating a modified host stratification system with treatment strategy selection, in an algorithmic approach, favourable outcomes were achieved in both high and low risk patients,’ said Marais.

‘In addition this approach maintained a low amputation rate, which is particularly relevant in a resource-poor clinical environment. We also reported novel data on the outcome of palliative treatment and the outcome of treatment in patients living with HIV,’ he added.

Marais is currently involved in various fields of research, including international multi-centre collaborations. He is continuing his research in the field of bone infections and will be concentrating on post-operative infections in HIV patients in the immediate future.

‘We have also been working on clinical markers predicting the presence of metastases at time of presentation in extremity osteosarcoma. The prognosis of children and adolescents who develop osteosarcoma remains poor.

‘In KwaZulu-Natal we seem to be dealing with a particularly aggressive osteosarcoma phenotype that has a high propensity to metastasise early and respond poorly to chemotherapy. I hope to secure funding to commence genetic characterisation of the osteosarcomas we see in children and adolescents. By identifying the genetic alterations associated I hope to identify novel targets for therapy in osteosarcoma,’ said Marais.

 Nombuso Dlamini