Calcium sulfate antibiotic carrier in the treatment of periprosthetic infection after arthroplasty and its effect on serum calcium

doi:10.12307/2021.268

Abstract

Abstract: BACKGROUND: Calcium sulfate, as an antibiotic carrier, has been widely used in the treatment of osteomyelitis, but its role in periprosthetic infection still needs to be further explored.
OBJECTIVE: To observe the effects of calcium sulfate sustained-release system on the treatment of periprosthetic joint infection following arthroplasty and the postoperative serum calcium concentration.
METHODS: Retrospective analysis was performed on 24 patients who were admitted to the Department of Orthopedics of the First Affiliated Hospital of Zhengzhou University and developed periprosthetic joint infection following arthroplasty from January 2019 to April 2020. Depending on the stage of the patient’s periprosthetic joint infection and whether there was etiological evidence, the patients were treated with arthroscopic debridement, incision debridement, one-stage revision arthroplasty or two-stage revision arthroplasty. All patients were implanted with a calcium sulfate sustained-release system intraoperatively. The trial was approved by the Ethics Committee of First Affiliated Hospital of Zhengzhou University (Approval No. 2020-KY-0229).
RESULTS AND CONCLUSIONS: (1) All patients completed the three-month follow-up. (2) The incidence of asymptomatic hypocalcemia was high. Specifically, two patients experienced hypocalcemia requiring emergency treatment, and one patient experienced hypercalcemia not requiring treatment at 1 day postoperatively. The preoperative and postoperative serum calcium levels were comparable in these patients. (3) Totally 23 patients had satisfactory wound healing, and the prosthesis was well positioned without recurrence of infection; one patient developed infection that recurred following reoperation. (4) In all the patients, erythrocyte sedimentation rate and C-reactive protein decreased significantly postoperatively (P < 0.01); Harris hip and knee scores improved postoperatively (P < 0.01). (5) These suggest that calcium sulfate sustained-release system can effectively improve periprosthetic joint infection following arthroplasty, and the patients are at a high risk of postoperative asymptomatic hypocalcemia.

Key words: calcium sulfate, serum calcium, periprosthetic joint infection, debridement antibiotics irrigation and implant retention, arthroplasty, artoroscopic debridement, arthrorevision, asymptomatic hypocalcemia, joint function recovery

CLC Number:

Gao Tianhao, Qian Huifang, Yang Shangliang, Xin Chaofei, Lu Shitao, Xu Jianzhong. Calcium sulfate antibiotic carrier in the treatment of periprosthetic infection after arthroplasty and its effect on serum calcium[J]. Chinese Journal of Tissue Engineering Research, 2021, 25(30): 4823-4827.

Figures/Tables 2

References

[1] MCLAWHORN AS, NAWABI DH, RANAWAT AS. Management of Resistant, Atypical and Culture-negative Periprosthetic Joint Infections after Hip and Knee Arthroplasty. Open Orthop J. 2016;10:615-632.
[2] NGUYEN M, SUKEIK M, ZAHAR A, et al. One-stage Exchange Arthroplasty for Periprosthetic Hip and Knee Joint Infections. Open Orthop J. 2016;10:646-653.
[3] DELLA VALLE CJ, ZUCKERMAN JD, DI CESARE PE. Periprosthetic sepsis. Clin Orthop Relat Res. 2004;(420):26-31.
[4] RISITANO S, SABATINI L, ATZORI F, et al. Static antibiotic spacers augmented by calcium sulphate impregnated beads in revision TKA: Surgical technique and review of literature. J Orthop. 2018;15(2): 313-318.
[5] FERGUSON J, DIEFENBECK M, MCNALLY M. Ceramic Biocomposites as Biodegradable Antibiotic Carriers in the Treatment of Bone Infections. J Bone Jt Infect. 2017;2(1):38-51.
[6] 林志炯,曾焘,高大伟.可吸收载药型硫酸钙治疗关节置换术后早期感染[J].中华关节外科杂志(电子版),2019,13(4):498-502.
[7] OUSSEDIK S, GOULD K, STOCKLEY I, et al. Defining peri-prosthetic infection: do we have a workable gold standard? J Bone Joint Surg Br. 2012;94(11):1455-1456.
[8] TANDE AJ, PATEL R. Prosthetic joint infection. Clin Microbiol Rev. 2014;27(2):302-345.
[9] AKGÜN D, PERKA C, TRAMPUZ A, et al. Outcome of hip and knee periprosthetic joint infections caused by pathogens resistant to biofilm-active antibiotics: results from a prospective cohort study. Arch Orthop Trauma Surg. 2018;138(5):635-642.
[10] MCCONOUGHEY SJ, HOWLIN R, GRANGER JF, et al. Biofilms in periprosthetic orthopedic infections. Future Microbiol. 2014;9(8): 987-1007.
[11] ABOSALA A, ALI M. The Use of Calcium Sulphate beads in Periprosthetic Joint Infection, a systematic review. J Bone Jt Infect. 2020;5(1):43-49.
[12] TSUKAYAMA DT, ESTRADA R, GUSTILO RB. Infection after total hip arthroplasty. A study of the treatment of one hundred and six infections. J Bone Joint Surg Am. 1996;78(4):512-523.
[13] 宋海波,陈洁,刘宏.关节镜下清创治疗人工膝关节置换术后早期感染的临床分析[J].中国骨伤,2017,30(4):318-321.
[14] 顾继生,蔡晓冰,朱明.载万古霉素MSNs复合硫酸钙制备人工骨的缓释与抗菌作用研究[J].生物骨科材料与临床研究,2019,16(1):8.
[15] 王宏,伍权,汤耿,等.个性化膝关节抗生素骨水泥占位器的设计及临床应用[J].中国组织工程研究,2020,24(6):821-826.
[16] INZANA JA, SCHWARZ EM, KATES SL, et al. Biomaterials approaches to treating implant-associated osteomyelitis. Biomaterials. 2016;81:58-71.
[17] MCNALLY MA, FERGUSON JY, LAU AC, et al. Single-stage treatment of chronic osteomyelitis with a new absorbable, gentamicin-loaded, calcium sulphate/hydroxyapatite biocomposite: a prospective series of 100 cases. Bone Joint J. 2016;98-B(9):1289-1296.
[18] FERGUSON JY, DUDAREVA M, RILEY ND, et al. The use of a biodegradable antibiotic-loaded calcium sulphate carrier containing tobramycin for the treatment of chronic osteomyelitis: a series of 195 cases. Bone Joint J. 2014;96-B(6):829-836.
[19] COOPER JJ, FLORANCE H, MCKINNON JL, et al. Elution profiles of tobramycin and vancomycin from high-purity calcium sulphate beads incubated in a range of simulated body fluids. J Biomater Appl. 2016; 31(3):357-365.
[20] SANICOLA SM, ALBERT SF. The in vitro elution characteristics of vancomycin and tobramycin from calcium sulfate beads. J Foot Ankle Surg. 2005;44(2):121-124.
[21] WAHL P, GUIDI M, BENNINGER E, et al. The levels of vancomycin in the blood and the wound after the local treatment of bone and soft-tissue infection with antibiotic-loaded calcium sulphate as carrier material. Bone Joint J. 2017;99-B(11):1537-1544.
[22] HELGESON MD, POTTER BK, TUCKER CJ, et al. Antibiotic-impregnated calcium sulfate use in combat-related open fractures. Orthopedics. 2009;32(5):323.

[23] JIANG N, LIU GQ, YANG JJ, et al. Is Hypercalcemia a Frequent Complication following Local Use of Calcium Sulfate with Antibiotics for the Treatment of Extremity Posttraumatic Osteomyelitis? A Preliminary Study. Biomed Res Int. 2019;2019:7315486.