Clinical Characteristics and Outcomes of Geriatric Calcaneal Osteomyelitis: A Synthesis Analysis of 333 Literature‐Reported Cases

AIM: The unique anatomical and functional features of the calcaneus pose continual challenges for orthopedic surgeons in treating calcaneal osteomyelitis (CO), particularly among older patients. Through a comprehensive analysis of cases documented in the literature, this study aims to provide a detailed overview of the clinical manifestations, therapeutic approaches, and treatment outcomes of geriatric calcaneal osteomyelitis (GCO). METHODS: A rigorous and systematic search was conducted across the PubMed, Embase, and the Cochrane Library databases to identify English language published studies that reported on CO among patients aged 60 years and above between the years 2000 and 2021. Quality assessment of the included studies was conducted using the National Institutes of Health (NIH) assessment scale, and effective data were extracted and pooled for analysis. RESULTS: A compilation of 59 articles encompassing 333 patients has been conducted, yielding a male-to-female ratio of 2.1 (215 males and 103 females). The median age at diagnosis was 62 years, and the median symptom duration was 6.6 months. The primary cause identified was diabetic foot-related infection (216 cases), with ulceration serving as the prominent symptom (285 cases). The positive pathogen culture rate was 94.6% (123/130), wherein polymicrobial infections accounted for 54.5% (67/123). Staphylococcus aureus emerged as the most frequently detected pathogen 17.1% (21/123), and fungal-related infections were isolated in five patients. Despite the majority of patients undergoing surgical interventions 97.6% (324/332), the overall recurrence rate was 30.7% (99/322). The infection relapse incidences following calcanectomy and debridement were 37.6% (82/218) and 19.4% (12/62), respectively. The cumulative risk of limb amputation amounted to 28.7% (95/331), with all-cause and CO-related mortality rates standing at 5.2% (17/328), in which one patient was reported to be related to CO. CONCLUSIONS: This study indicated that GCO primarily impacts males, with diabetic foot as the primary contributing factor. Staphylococcus aureus remained the most frequently isolated pathogen. Surgical intervention was the primary treatment modality, and the incidences of infection recurrence and limb amputation were around 30%.