Dual Role of Calcium Sulfate Beads in Infection Prophylaxis and Treatment in Orthopaedic Surgery

Abstract

Introduction

Infection following an orthopaedic injury or surgery can be detrimental to patients and hospitals alike. Proper prevention and treatment is crucial towards minimizing increased morbidity. This study aims to determine the efficacy of calcium sulfate beads in both infection prophylaxis and treatment in various locations. 

Methods

Retrospective review was conducted on a multi-institutional infection dataset for any patients receiving calcium sulfate beads for infection prophylaxis or treatment. Beads were placed either intramedullary, intraarticular, soft tissue or bony defect and mixed with culture specific antibiotics if available. Patients were monitored post operative for postoperative complications, and any return to the operating room to determine infection clearance and any related adverse events. 

Results

201 patients were followed postoperatively after receiving calcium sulfate beads for 1-2 years. Compared to intramedullary placement, intraarticular beads had an OR of 0.70, bony defect placement OR 1.40, and soft tissue placement OR 1.16 of infection clearance, however no statistically significant differences. Fungal infections were associated with 90-day readmissions (OR 6.0, p = 0.007), whereas gram-positive and gram-negative infections were not. Overall, 13.4% of patients returned to the operating room within 1 year due to reinfection. 

Conclusion

Calcium sulfate beads are an effective means of both preventing and treating infection following orthopaedic surgery. While effective in all settings, we found the lowest rate of return to the operating room when used in the joint space and soft tissue spaces. More research is needed to understand this relationship. 

Keywords: Calcium Sulfate Beads, Infection, Periprosthetic Joint Infection