Treatment of chronic osteomyelitis by necrectomy and gentamicin-PMMA beads.

Irrigation and suction-drainage have certain disadvantages in the treatment of chronic osteomyelitis. Some of these are: a long bed-restricted postoperative period; necessity of constant control of the flow system; careful and continuous physician and nursing care, and high costs of hospitalization. A new procedure, designed by Klemm, is the use of gentamicin-polymethylmethacrylate (G-PMMA) beads strung in chains after necrectomy. High local concentrations of antibiotic are achieved without systemic toxic side effects. External fixation is to be used when excessive dead bone resection produces instability, and cancellous grafting when significant bone defects that disturb bone healing must be filled. In the period between 1974 and 1979 more than 120 patients with chronic osteomyelitis were managed with this method. Twenty-five cases were available for follow-up three to five years after treatment: 96% had considerable improvement of their condition, and 88% became asymptomatic with no evidence of infection. G-PMMA bead treatment is encouraging not only for the high success rate, but also because it might eliminate the need for prolonged hospitalization.