Dissolvable Antibiotic Beads in Treatment of Periprosthetic Joint Infection and Revision Arthroplasty - The Use of Synthetic Pure Calcium Sulfate (Stimulan®) Impregnated with Vancomycin & Tobramycin

Abstract

This study reviews the clinical results using commercially pure, synthetic antibiotic-loaded Calcium Sulfate dissolvable beads (Stimulan, Biocomposites, Ltd., Keele, UK) in 250 cases of aseptic and septic revision total hip and total knee arthroplasty. A set protocol of Vancomycin and Tobramycin antibiotic was used in all cases. The rate of wound drainage in this series was 3.2%. Wound drainage was generally seen in cases using higher bead volumes. The incidence of heterotopic bone formation was 1.2%. There were nine failures in this study, six of which were due to infection. We feel that commercially pure, synthetic antibiotic-loaded dissolvable beads are an acceptable delivery tool for local antibiotic delivery in aseptic and septic revision joint arthroplasty of the hip and knee. Further studies are needed to examine the potential of improving outcomes of periprosthetic joint infection with this particular local antibiotic delivery system.Key words: Stimulan, Calcium Sulfate, Antibiotic Beads, Periprosthetic Infection, Revision Arthroplasty. Level of Evidence:  AAOS Therapeutic Study Level IV.