Is instillation drainage for the treatment of infected joints, bones and soft tissues still up to date?

For the treatment of infected joints, bones and soft tissues, either an instillation drainage therapy or the use of gentamicin-polymethyl-methacrylate (PMMA) chains (Septopal) in addition to surgical revision and systemically given antibiotics is currently in clinical use. We investigated 102 patients treated in our clinic by means of instillation drainage and compared the results with those obtained with gentamicin-PMMA chains by other authors. The overall long-term success with non-recurrence of the infection is nearly comparable (80% instillation drainage, 84% gentamicin-PMMA chains); however, with instillation drainage the duration of hospitalisation is significantly longer (mean 42.26 days vs 15.3 - 33 days). Additionally, there was a high rate of germ shifts with instillation drainage (33.3%) and a disappointing result in 20 infected endoprostheses (9 recurrences with 11 revisions). Regarding the intensive nursing care required and the necessary isolation from other patients, instillation drainage can only be recommended for the therapy of infected joints, bones and soft tissues if the results are better in comparison with gentamicin-PMMA chains. An improvement may be achieved with the closed instillation drainage system.