Refractory Osteomyelitis (Bone Infection)

Chronic Osteomyelitis
Refractory Osteomyelitis
Chronic Bone Infection


Chronic refractory osteomyelitis is an infection of bone which has persisted or recurred after an intial course of treatment for osteomyelitis.


The factor that frequently makes chronic osteomyelitis difficult to cure is impaired blood flow at the site of infection. Impaired blood flow can be the result of previous trauma, multiple surgeries, retained hardware, underlying chronic disease (i.e. diabetes, peripheral vascular disease, etc.)  This often results in low levels of oxygen at the bone infection site. The combination of infection and low levels of oxygen can result in the development of dead bone and/or scar tissue which interfere with the body's responses for dealing with the infection as well as the delivery of antibiotics to the site of infection.


Additionally, the body's specialized cells used for removing infected/dead bone and replacing with healthy bone is dependent on oxygen. Low levels of oxygen at the site of infection make these cells function poorly as well and interferes with bone remodelling. 


Evaluation of chronic refractory osteomyelitis starts with confirmation of the diagnosis and establishment of the bacterial organism(s) causing the infection. The diagnosis is confirmed by history, examination and imaging studies. Once the diagnosis of chronic osteomyelitis is confirmed a treatment plan is formulated which often includes hyperbaric oxygen therapy, antibiotics and likely surgical intervention to remove infected bone or hardware (if necessary).


The overwhelming majority of published data support hyperbaric oxygen therapy use as safe and effective when incorporated into a comprehensive treatement plan. When used appropriately, hyperbaric oxygen therapy can reduce the total need for surgical procedures and required antibiotic therapy.


Additional indications for hyperbaric oxygen therapy may be discussed with your doctor and the Hyperbaric Medicine Team. Hyperbaric oxygen therapy is most frequently used with additional care the patient is receiving. Additional treatments may also include antibiotic therapy, nutritional support and surgical procedures, if indicated.  Our Hyperbaric Medicine Team will work closely with your physician(s) to coordinate any additional care needed.


The above information was obtained from:

Strauss MB, Miller SM. The Role of Hyperbaric Oxygen in the Management of Chronic Refractory Osteomyelitis. In: Hyperbaric Medicine Practice 3rd edition ed  E. Kindwall. Best Publishing, Flagstaff, AZ;  2008 P.677-709
Hart B. Refractory Osteomyelitis.  Hyperbaric Oxygen Therapy Indications, 12th Edition, Undersea and Hyperbaric Medical Society, Durnham, NC 2008


Contact the Hyperbaric Medicine Department at MemorialCare, Long Beach Medical Center for more information.

MemorialCare, Long Beach Medical Center
Department of Hyperbaric Medicine
2801 Atlantic Avenue
Long Beach, California 90806

Telephone: (562) 933-6960

 Fax: (562) 933-6060