Bone Anchor Infections in Female Pelvic Reconstructive Procedures: A Literature Review of Series and Case Reports

Actinomyces meyeri osteomyelitis of the symphysis pubis following pubovaginal sling

“…Leukocytosis and radiographic findings of irregular bony margins as well as rarefaction and widening of the symphysis pubis space may also be present. The etiology of osteitis pubis remains unclear, but the condition may be due to surgical trauma of the pubis via retractors, sharp dissection, electrocautery, suture placement, or impaired venous circulation [17]. The diagnosis of osteomyelitis is similar to that of osteitis pubis, but the clinical course is progressive.…”

“…The bone anchors were removed successfully from all patients; however, residual problems included urinary incontinence (five of nine patients) and chronic pain (three of nine) patients. Through July 2000, Rackley et al [17] reviewed approximately 30 reports involving more than 1,000 patients to estimate the prevalence of bone-anchor-related infections in female pelvic reconstructive procedures as 0.6%. More recently, Goldberg et al [19] reported three cases of pubic osteomyelitis among 225 patients after bone anchoring procedures for stress incontinence.…”

“…Plain anteroposterior and pelvic outlet radiography, CT, MRI, and bone scans detect radiographic changes that range from minimal findings initially to irregular, localized bone destruction in osteomyelitis [17]. Bone scans are typically positive within 24 h of symptom onset.…”

“…When detection is delayed and bony changes of necrosis appear, surgical debridement and curettage of the affected bone and removal of all foreign bodies are needed in addition to long-term antibiotic therapy [17].…”

Lessons from the past: directions for the future

“…Bone anchor osteomyelitis probably occurs in less than 1% of the procedures [9,10]. But, osteomyelitis can be debilitating and turn a perfectly healthy woman into a wheelchair-bound person.…”