Clinical relevance of histopathology in foot osteomyelitis in diabetic osteoarthropathy

E.P. Burleva¹, Yu.V. Babushkina², L.N. Zaytseva¹

¹Ural State Medical University, Yekaterinburg

²Sverdlovsk Regional Clinical Hospital No. 1, Yekaterinburg

Aim: to assess the clinical relevance of osteomyelitis histopathology in diabetic osteoarthropathy.

Patients and Methods: clinical data of 17 patients with osteomyelitis in diabetic osteoarthropathy and histological samples collected during surgical resection were studied. At baseline, all patients were divided into three groups. Group 1 included 12 patients with acute osteomyelitis or its flare-up. Group 2 included 2 patients with quiescent chronic osteomyelitis. Group 3 included 3 patients with diabetic osteoarthropathy and soft tissue infection. Middle and posterior portions of the foot were predominantly affected (n=16). Standard histopathology with H&E stain and van Gieson’s stain was performed. Semi-quantitative assessment of samples using the Histopathological Osteomyelitis Evaluation Score (HOES), its sensitivity, specificity, the positive and negative prognostic value was determined. Clinical diagnoses and morphological reports were compared.

Results: two groups of conditions were isolated based on histopathology, i.e., osteomyelitis in diabetic osteoarthropathy (n=14: chronic osteomyelitis, n=13, and acute osteomyelitis, n=1) and diabetic osteoarthropathy without osteomyelitis (n=3). A description of these processes was provided. Articular cartilage lesions (e.g., dystrophy, thinning, and cracks) were diabetic osteoarthropathy hallmarks. Osteonecrosis, bone remodeling, and fibrosis were typical for diabetic osteoarthropathy and osteomyelitis. Cellular infiltration with lymphocytes and polymorphonuclear leukocytes (characteristic of infections) was also seen at the inflammatory phase of diabetic osteoarthropathy. Significant neutrophil infiltration of the bone marrow was a relevant morphological criterion of acute osteomyelitis in diabetic osteoarthropathy (n=1). Meanwhile, no relevant criteria for chronic (even active) osteomyelitis were identified. HOES sensitivity was 68.4%, specificity 20%, positive prognostic value 64.7%, and negative prognostic value 11.8%.

Conclusion: given similar histopathology (particularly in chronic osteomyelitis), the histopathological report cannot be considered a single criterion to verify osteomyelitis in diabetic osteoarthropathy. Both histopathology and HOES should be used to assess retrospectively non-invasive diagnostic tools for diabetic osteoarthropathy and osteomy elitis in diabetic osteoarthropathy.

Keywords: diabetic osteoarthropathy, osteomyelitis, histopathology, morphological diagnosis, Histopathological Osteomyelitis Evaluation Score.

For citation: Burleva E.P., Babushkina Yu.V., Zaytseva L.N. Clinical relevance of histopathology in foot osteomyelitis in diabetic osteoarthropathy. RMJ. 2022;1:3–8.