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Resident PGY 2
Henry Ford Hospital
Title: Outcomes of Irrigation and Debridement in Periprosthetic Joint Infections Using Antibiotic-Impregnated Calcium Sulfate Beads. Purpose: The use of dissolvable antibiotic-impregnated calcium sulfate beads as an adjunct to systemic antibiotics has been proposed as a potential strategy to increase success of treatment of periprosthetic joint infection (PJI). Currently, there is limited information regarding the efficacy of this strategy and prior studies have suggested poor utility. The purpose of this investigation was to evaluate the effect of bead placement in acute PJI, and to delineate populations (acute postoperative vs acute hematogenous vs chronic) that may benefit most. Methods: Retrospective review of patients who previously underwent total hip arthroplasty (THA) or total knee arthroplasty (TKA) requiring a revision surgery that included use of antibiotic-impregnated calcium sulfate beads from March 2015 through September 2017. Patients were identified through a query using the billing codes for the antibiotic beads. Out of the 193 patients queried, 85 patients (29 THAs, 56 TKAs) met inclusion criteria. Patients were stratified into subgroups based on infection type (acute postoperative, acute hematogenous and chronic). Infection was confirmed by presence of MSIS criteria. Primary outcome measure was implant retention. A multivariate analysis was then performed to determine which factors lead to treatment success. Results: Of the 85 patients, 51 had implant retention and 34 required removal of implants. The overall implant retention rate in the acute postoperative cohort was 79% (33/42) compared to both the chronic cohort 38% (11/29) and the acute hematogenous cohort 50% (7/14) with p-values of <0.001 and 0.084 respectively. Additionally, the rate of implant retention was found to be higher in the TKA group 68% (38/56) as compared to the THA group 45 % (13/29) with a p-value of 0.040. Conclusion: The use of dissolvable antibiotic-impregnated calcium sulfate beads does appear to provide benefit in select patients with PJI. Rates of implant retention following irrigation and debridement are favorable, most notably in the acute postoperative PJI cohort. These results differ from previous studies that suggest the beads are ineffective, warranting further high quality investigation.
Maier, Lindsay; Kadado, Allen; Matar, Robert; Davis, Jason J.; and Charters, Michael A., "Outcomes of irrigation and debridement in periprosthetic joint infections using antibiotic-" (2019). Clinical Research. 29.