Treatment of bone and soft-tissue infections with gentamicin-polymethyl-methacrylate chains. A review of clinical trials involving 1 500 cases.

In vitro and in vivo experimental work showed that gentamicin-polymethyl-methacrylate (G-PMMA) provides bactericidal gentamicin concentrations at the site of infection but very low systemic concentrations, suggesting advantages as regards infection control and lack of side-effects. During the past 4 years 1247 osteomyelitis patients have been treated with G-PMMA at 11 clinics. The early postoperative results showed control of infection in 90.8% of cases. Infection persisted in 9.2% owing to remaining sequestra, osteosynthetic material, etc. This indicates the importance of good and radical surgery. Follow-up of 355 patients for 3 - 54 months postoperatively showed relapses in only 27 cases. A total of 361 patients with soft-tissue infections (e.g. associated with bone infections, sacral cavity after rectum excision, abscesses, etc.) underwent treatment with G-PMMA after thorough debridement, with good results. Techniques for implantation, and removal of the chains are discussed. No adverse effects have been observed in this series of trials.