Hypercalcaemia following the use of antibiotic-eluting absorbable calcium sulphate beads in revision arthroplasty for infection

Abstract

Periprosthetic joint infection (PJI) is a devastating complication for patients and results in greatly increased costs of care for both healthcare providers and patients. More than 15 500 revision hip and knee procedures were recorded in England, Wales and Northern Ireland in 2013, with infection accounting for 13% of revision hip and 23% of revision knee procedures. We report our experience of using antibiotic eluting absorbable calcium sulphate beads in 15 patients (eight men and seven women with a mean age of 64.8 years; 41 to 83) as part of a treatment protocol for PJI in revision arthroplasty. The mean follow-up was 16 months (12 to 22). We report the outcomes and complications, highlighting the risk of hypercalcaemia which occurred in three patients. We recommend that serum levels of calcium be routinely sought following the implantation of absorbable calcium sulphate beads in orthopaedic surgery.

Symptomatic Hypercalcaemia Following the Use of Dissolvable Antibiotic Beads in Infected Total Knee Arthroplasty

“…Kallala et al describes a case report of 15 patients whom received absorbable calcium beads following infected prosthetic joint revision surgery of the hip and knee. They found that 3 patients developed hypercalcaemia with 1 patient requiring treatment in the form of intravenous rehydration and bisphosphonates [10]. The paper concluded that they recommend routine serum calcium measurements postoperatively in patients who have had absorbable calcium beads inserted.…”

“…The aim of the case report is to highlight the risk of hypercalcaemia from the use of antibiotic loaded calcium sulphate beads and ensure doctors take suitable precautions to either prevent this from happening, or diagnose and treat promptly. A review of the surrounding literature shows that this complication has been previously reported [10]; however, no cases published thus far have required surgical intervention to normalise calcium levels.…”

Total Knee Arthroplasty: The Efficacy of Calcium Sulfate Beads in One-Stage Aseptic Revision

“…In one revision TKA, there was a case of persistent wound drainage that resolved without surgical intervention. Additionally, Kallala and Haddad studied 15 hip and knee revision patients that were implanted with CSBs in an observational case series [26]. They found that one patient had clinical signs of infection with raised inflammatory markers at final follow-up.…”

Current Options and Emerging Biomaterials for Periprosthetic Joint Infection

“…Vancomycin and tobramycin were used in calcium sulfate beads at each surgery and results demonstrated an overall 2.4% failure due to recurrent infection or new infection. Finally, a cohort of 15 patients treated with single-stage revision and calcium sulfate beads reported a 20% rate of hypercalcemia, with one of three patients with hypercalcemia requiring treatment for this complication [59]. Commercially prepared calcium sulfate with tobramycin (OSTEOSET, Wright Medical) has been approved for use in other countries; however, antibiotic-laden calcium sulfate is not yet approved for use in the USA.…”