Abstract
Local delivery of high-dose antibiotics via absorbable calcium sulfate beads has been
investigated as a treatment of prosthetic joint infection (PJI). We investigate this
strategy as a prophylactic measure for high-risk patients undergoing primary total
knee arthroplasty (TKA). A retrospective review of a single-surgeon consecutive series
of primary TKA patients with identified risk factors for PJI development was performed.
These patients were treated with calcium sulfate beads containing 1 g of vancomycin
and 1.2 g of tobramycin per 10 cc, with 10 cc placed intraarticularly. Outcomes included
PJI, wound complications, revision surgery, and medical complications. There were
114 knees in 103 patients, with 76 women (66.7%), a mean age of 66.8 years (range:
21–91), and a mean follow-up of 16 months (range: 3–55). The mean preoperative lifetime
PJI risk based on the 2018 International Consensus Meeting on the PJI calculator was
11.3% (standard deviation: 16.3%, range: 0.9–94.3%). Risk factors included medical
comorbidities, homelessness, chronic urinary tract infection, other PJI or septic
arthritis history, or prior ipsilateral knee surgeries. One delayed PJI occurred 1
year postoperatively from presumed hematogenous seeding following dialysis. There
were no other known deep infections. There were nine patients who had delayed wound
healing with marginal skin necrosis—six resolved with wound care and three underwent
superficial extraarticular surgical debridement. There was one patient who underwent
aseptic revision for patellar instability and nine patients required manipulation
under anesthesia for stiffness. There was one patient who died after readmission for
cardiac arrhythmia and one patient had bilateral DVT. No cases of chronic PJI, persistent
wound drainage, or postoperative hypercalcemia were identified. Prophylactic use of
antibiotic-eluting calcium sulfate beads in primary TKA has resulted in low rates
of early PJI in a high-risk cohort, warranting further prospective studies and investigation.
Keywords
knee - periprosthetic joint infection - infection - prevention - prophylaxis - antibiotic
beads