{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,7]],"date-time":"2026-07-07T17:19:23Z","timestamp":1783444763305,"version":"3.54.6"},"reference-count":58,"publisher":"Bioscientifica","issue":"9","license":[{"start":{"date-parts":[[2026,2,13]],"date-time":"2026-02-13T00:00:00Z","timestamp":1770940800000},"content-version":"vor","delay-in-days":1626,"URL":"https:\/\/creativecommons.org\/licenses\/by-nc\/4.0\/"}],"content-domain":{"domain":["journals.bioscientifica.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,9,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>Osteomyelitis refers to an inflammatory process causing bone destruction and necrosis. Managing such a persistent disease is complex, with a number of authors reporting different techniques. This scoping review aims to map and summarize the literature on treatment of chronic femoral and tibial osteomyelitis, in order to improve the reader\u2019s understanding of potential treatments and identify areas of further research. The methodological framework of the Joanna Briggs Institute was followed. A computer-based search was conducted in PubMed, EMBASE, MEDLINE, EMCARE and CINAHL, for articles reporting treatment of chronic tibial\/femoral osteomyelitis. Two reviewers independently performed title\/abstract and full-text screening according to pre-defined criteria. A total of 1230 articles were identified, with 40 finally included. A range of treatments are reported, with the core principles being removal of infected tissue, dead-space management and antibiotic therapy. The majority (84.5%) of patients presented with stage III or IV disease according to the Cierny\u2013Mader classification, and Staphylococcus aureus was the most commonly isolated organism. The proportion of patients achieving remission with no recurrence during follow-up varies from 67.7\u2013100.0%. The majority of studies report excellent outcomes in terms of infection remission and lack of recurrence. However, identifying specific patient or treatment-related factors which may affect outcomes is currently challenging due to the nature of the included studies and unclear reporting of treatment outcomes. It is now important to address this issue and identify such factors using further high-level research methods such as randomized controlled trials and comparative cohort studies.<\/jats:p>\n                  <jats:p>Cite this article: EFORT Open Rev 2021;6:704-715. DOI: 10.1302\/2058-5241.6.200136<\/jats:p>","DOI":"10.1302\/2058-5241.6.200136","type":"journal-article","created":{"date-parts":[[2021,9,14]],"date-time":"2021-09-14T10:42:48Z","timestamp":1631616168000},"page":"704-715","update-policy":"https:\/\/doi.org\/10.1530\/crossmarkpolicy-16","source":"Crossref","is-referenced-by-count":36,"title":["Management of chronic osteomyelitis of the femur and tibia: a scoping review"],"prefix":"10.1530","volume":"6","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2143-7792","authenticated-orcid":false,"given":"Zaki","family":"Arshad","sequence":"first","affiliation":[{"name":"1University of Cambridge School of Clinical Medicine, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward Jun-Shing","family":"Lau","sequence":"additional","affiliation":[{"name":"1University of Cambridge School of Clinical Medicine, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1478-8399","authenticated-orcid":false,"given":"Aiman","family":"Aslam","sequence":"additional","affiliation":[{"name":"1University of Cambridge School of Clinical Medicine, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3394-9418","authenticated-orcid":false,"given":"Azeem","family":"Thahir","sequence":"additional","affiliation":[{"name":"2Department of Trauma and Orthopaedic Surgery, Addenbrooke\u2019s Hospital, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Matija","family":"Krkovic","sequence":"additional","affiliation":[{"name":"2Department of Trauma and Orthopaedic Surgery, Addenbrooke\u2019s Hospital, Cambridge, UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"416","published-online":{"date-parts":[[2021,9,14]]},"reference":[{"key":"2026070711362093500_bibr1-2058-5241.6.200136","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.jor.2016.10.004","article-title":"Osteomyelitis: recent advances in pathophysiology and therapeutic strategies","volume":"14","author":"Birt","year":"2017","journal-title":"J Orthop"},{"key":"2026070711362093500_bibr2-2058-5241.6.200136","doi-asserted-by":"crossref","first-page":"128","DOI":"10.1302\/2058-5241.1.000017","article-title":"Chronic osteomyelitis: what the surgeon needs to know","volume":"1","author":"Panteli","year":"2016","journal-title":"EFORT Open 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adult","volume":"14","author":"Maffulli","year":"2016","journal-title":"Surgeon"},{"key":"2026070711362093500_bibr7-2058-5241.6.200136","doi-asserted-by":"crossref","first-page":"783","DOI":"10.1302\/0301-620X.96B6.32244","article-title":"The treatment of intramedullary osteomyelitis of the femur and tibia using the Reamer-Irrigator-Aspirator system and antibiotic cement rods","volume":"96-B","author":"Kanakaris","year":"2014","journal-title":"J Bone Joint Surg [Br]"},{"key":"2026070711362093500_bibr8-2058-5241.6.200136","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1186\/1477-7819-11-283","article-title":"Osteomyelitis of the femur mimicking bone tumors: a review of 10 cases","volume":"11","author":"Huang","year":"2013","journal-title":"World J Surg Oncol"},{"key":"2026070711362093500_bibr9-2058-5241.6.200136","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1016\/0002-9343(86)90505-X","article-title":"Antibiotics delivered by an implantable drug pump: a new application for treating osteomyelitis","volume":"80","author":"Perry","year":"1986","journal-title":"Am J Med"},{"key":"2026070711362093500_bibr10-2058-5241.6.200136","first-page":"91","article-title":"Results of chronic osteomyelitis of the femur treated with hyperbaric oxygen: a preliminary report","volume":"27","author":"Chen","year":"2004","journal-title":"Chang Gung Med J"},{"key":"2026070711362093500_bibr11-2058-5241.6.200136","doi-asserted-by":"crossref","first-page":"393","DOI":"10.1186\/s13018-019-1388-2","article-title":"A systematic review of the single-stage treatment of chronic osteomyelitis","volume":"14","author":"Pincher","year":"2019","journal-title":"J Orthop Surg Res"},{"key":"2026070711362093500_bibr12-2058-5241.6.200136","doi-asserted-by":"crossref","first-page":"219","DOI":"10.1080\/23744235.2019.1695059","article-title":"The role of bioactive glass in the management of chronic osteomyelitis: a systematic review of literature and current 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Chapter 7: systematic reviews of etiology and risk. In: AromatarisEMunnZ eds. JBI manual for evidence synthesis. 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