Document Type : SYSTEMATIC REVIEW
ja Krkovic PhD FRCS1 1 Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, Hills Road, Cambridge, United Kingdom
School of Clinical Medicine, University of Cambridge, Hills Road, Cambridge, United Kingdom
Department of Trauma and Orthopaedics, Addenbrookes Major Trauma Unit, Cambridge University Hospitals, Hills Road, Cambridge, United Kingdom
Background: Calcium sulphate is a recent alternative for delayed antibiotic elution in infected bones and joints. The
purpose of this study is to evaluate the use of antibiotic impregnated calcium sulphate (AICS) beads in the management
of infected tibia and femur, with regards to patient outcomes and complication rates (including reinfection rate, remission
rate and union rate).
Methods: Searches of AMED, CINAHL, EMBASE, EMCARE, Medline, PubMed and Google Scholar were conducted
in June 2020, with the mesh terms: “Calcium sulphate beads” or “Calcium sulfate beads” or “antibiotic beads” or
“Stimulan” AND “Bone infection” or “Osteomyelitis” or “Debridement” AND “Tibia” or “Femur”. Risk of bias was assessed
using the Risk of Bias in Non-randomised Studies of interventions (ROBINS-i) tool, and quality assessed via the
Grading of Recommendations, Assessment, Development and Evaluation (GRADE) criteria.
Results: Out of 104 relevant papers, 10 met the inclusion criteria for data extraction. Total infection remission was
6.8%, which was greater than that of polymethylmethacrylate (PMMA, 21.2%). Complication rates varied. The main
issue regarding AICS use was wound drainage, which was considerably higher in studies involving treatment of tibia
alone. Studies using PMMA did not experience this issue, but there were a few incidences of superficial pin tract
infection following surgery.
Conclusion: Where AICS was used, it was consistently effective at infection eradication, despite variation in causative
organism and location of bead placement. Wound drainage varied and was higher in papers regarding tibial cases alone.
Level of evidence: III