5.3. The management of Chronic Osteomyelitis and Septic Arthritis (continue)
4. The role of antibiotics 
It seems reasonable to give parenterally one or more appropriate bactericidal antibiotics to ‘cover’ this extensive surgery and to commence this one or two days preoperatively.
5. Continuous post-operative irrigation
This has also been used in the surgical management of chronic osteomyelitis, but it demands care, and the involvement of an interested and available surgeon.
6. Post-operative management
Apart from the necessary wound care important decisions have to be made:
1. When should movement of the local joints commence?
2. When can the patient start to walk?
3. When can peri-operative antibiotics be stopped?
We suggest:
1. Gentle passive movement can probably start within a very few days after operation, and quadriceps exercises and movement of the patella even earlier.
If all goes well with the wound then both
active and passive exercising can be steadily increased but of course must
always be related to the local conditions, and the unlikely appearance of
any consitutional symptoms or signs. Again it is wise ‘to make haste
slowly’.
2. The decision to allow a patient to start walking depends on many factors, and it is for each surgeon to decide this in consultation with the patient and any available and relevant para-medical staff. Obviously much will depend on the amount of living bone that had to be removed (and therefore how much remains) as well as the personality of the patient and his or her cooperation (no weight bearing, partial weight bearing, full weight bearing).
3. When to stop antibiotics? It is probably reasonable to stop prophylactic antibiotic therapy when the wound is soundly healed. This may not always occur, and then careful judgement is necessary. However, in this situation our feeling is to stop these drugs six weeks after the sequestrectomy unless there is a positive indication to continue (rarely in practice).