Summary: At local elution levels of antibiotic at 100-1000 times MIC, without detectable serum levels of the antibiotics, calcium sulfate hemihydrate pellets can be used as a local carrier for antibiotics to kill biofilm, and is safe to use for prevention and treatment of infected joints.

Background

Antibiotic-impregnated pellets and cement are commonly used as treatment for osteomyelitis and biofilm-related infection. We studied the utility of 100% pure synthetic calcium sulfate hemihydrate pellets impregnated with 240 mg liquid tobramycin and 500 mg vancomycin powder per 10 cc mixture (PSCSH-TOB-VAN) in both septic and aseptic one-stage revision arthroplasties for total hips and total knees. These beads are biodegradable and provide concentrations between 100-1000 times MIC locally without detectable levels in the serum. These pellets soften secondary to hydration almost instantly when placed in a surgical bed.

Methods

466 patients from 2016-2019 were reviewed in a retrospective study. We reviewed patient demographics, physical exam findings, and patient history along with routine labs, and staging studies (bone scan, WBC scan, and CT) to identify patients. We also analyzed the volume of PSCSH-TOB-VAN used and complications such as postoperative drainage and heterotopic ossification.

Results

Of the 466 patients included in this study, 202 are male and 264 are female. The average age was 62 years with a range from 20 to 92 years. The average BMI of our patients was 31.8. 159 patients (34.1%) had periprosthetic joint infections (PJI) as their preoperative diagnosis, of these, 150 (94.3%) had McPherson III-C-3 PJI. PSCSH-TOB-VAN disappeared on x-ray imagery an average of 3 weeks postoperatively. The average volume of PSCSH-TOB-VAN used in these patients was 24 mL with a range from 20-100 mL, depending on the size of the incision site. 133 of our patients (28.5%) had postoperative drainage due to increased PSCSH-TOB-VAN volume usage, most of which were able to be treated conservatively with a wound vac. 37 patients (0.08%) needed reoperation due reinfection.

Conclusion

With our 466 patients as evidence, PSCSH-TOB-VAN is an acceptable tool to be used in an antibiotic carrier with high elution profiles that can kill biofilm. It can be used in infected knees postsurgically and in infected arthroplasties to significantly reduce recurrence of the infection. Since PSCSH-TOB-VAN is soft upon hydration, it does not scratch the cartilage in knees or the joint in the treatment of PJI. At local elution levels of antibiotic at 100-1000 times MIC, without detectable serum levels of the antibiotics, PSCSH-TOB-VAN kills biofilm and is safe to use. With further studies, PSCSH could potentially provide high dosing of a variety of other local drug treatments, including chemotherapeutic agents such as doxorubicin, and pain control targeting opioid receptors. This could be extremely beneficial in mitigating systemic effects of the drugs.

Analysis of bone union after biplanar medial closing wedge distal femoral osteotomy ePoster Presentation Takehiko Matsushita, MD, PhD, JAPAN Shinya Oka, MD, PhD, JAPAN Akiyoshi Mori, JAPAN Shu Watanabe, MD, JAPAN Kiminari Kataoka, MD, JAPAN Koji Nukuto, MD, PhD, UNITED STATES Daisuke Araki, MD, PhD, JAPAN Yuichiro Nishizawa, MD, PhD, JAPAN Kanto Nagai, MD, PhD, JAPAN Noriyuki Kanzaki, MD, PhD, JAPAN Yuichi Hoshino, MD, PhD, JAPAN Ryosuke Kuroda, MD, PhD, JAPAN
Reattachment Of Posterior Cruciate Ligament Bony Avulsion Without Capsulotomy Using Transverse Posterior Incision – 'A Technical Note' Abstract Presentation 6 minutes Sharath Kittanakere Ramanath, MS DNB Ortho, INDIA
Opioid Reduction After Knee And Shoulder Arthroscopy: A Systematic Review And Meta-Analysis Of Randomized Controlled Trials ePoster Presentation Kyle Gouveia, MD, CANADA Haseeb Ahmed Faisal, BHSc(Cand), CANADA Jessica Gormley, MD(Cand), CANADA Harsha Shanthanna, MD, PhD, FRCPC, CANADA Moin Khan, MD, MSc, FRCSC, CANADA Kim Madden, PhD, CANADA
Prospective Randomised Controlled Trial Of Three Tibial Component Fixation Techniques: Medium To Long Term Functional And Radiological Outcomes ePoster Presentation Myles R. J. Coolican, FRACS, AUSTRALIA Darshan Srishail Angadi, MBBS, MRCS, PGCert, FRCS (Tr &Orth), MD(Research) , INDIA Vikram K. Kandhari, MS, DNB, UNITED KINGDOM
Novel Solution Using Viable Cartilage Allograft For Focal Cartilage Defects Abstract Presentation 5 minutes Deryk G. Jones, MD, UNITED STATES Bhumit Desai, MD, UNITED STATES Emmanuel Koli, MD, UNITED STATES Michael Warren, MD, UNITED STATES Gerard Karl Williams Jr., MD, UNITED STATES Graylin Jacobs, CRC, UNITED STATES Walter Stephen Choate, MD, UNITED STATES Scott C Montgomery, MD, UNITED STATES Misty Suri, MD, UNITED STATES
Patient´S Sex And Height Predict Graft Size But Graft Size Does Not Influence Risk Of Graft Failure. A Study Of 4519 Patients With Primary Anterior Cruciate Ligament Reconstruction. ePoster Presentation Vasileios Sarakatsianos, MD, SWEDEN Riccardo Cristiani, MD, PhD, SWEDEN Marita L Harringe, PhD, RPT, SWEDEN Gunnar Edman, MD, PhD, Prof., SWEDEN Anders Stalman, MD, PhD, associate professor, SWEDEN
Orthopedic Sports Medicine Topics Rank Low A Consensus Study From Local And International Experts On A Musculoskeletal Curriculum In Southern Africa. ePoster Presentation Michael Held, MD, PhD, SOUTH AFRICA Maritz Laubscher, MD, SOUTH AFRICA Nicholas Kruger, FC Orth SA, MMed, SOUTH AFRICA Robert N Dunn, FC Orth SA, MMed, SOUTH AFRICA
Enhanced miRNA 140 and Hyaluronic acid expression in in vitro cultured human chondrocytes derived from OA affected cartilage tissue; An ideal tool for ACI and MACI ePoster Presentation Samuel Jk Abraham, MD, PhD, JAPAN Hiroshi Yoshioka, MD, JAPAN Senthilkumar Rajappa, PhD, INDIA Senthilkumar Preethy, BDS, MSc.,, INDIA Karthick Ramalingam, MSc, INDIA Rajmohan Mathaiyan, MSc, INDIA Akimasa Seno, PhD, JAPAN Masaharu Seno, PhD, JAPAN Shojiro Katoh, MD, JAPAN
Evaluation Of Cartilage Repair After Open-Wedge High Tibial Osteotomy Using T2 Mapping Methods ePoster Presentation Ken Iida, MD, JAPAN Yusuke Hashimoto, MD, PhD, JAPAN Yohei Nishida, MD, JAPAN Shinya Yamasaki, MD, PhD, JAPAN Hiroaki Nakamura, MD, PhD, JAPAN
Transtibial Pullout And Partial Meniscectomy For Medial Posterior Meniscal Root Tears In Middle-Aged Patients: Risk Factors And Midterm Clinical Outcomes. A Case-Control Study Abstract Presentation 6 minutes Lika Dzidzishvili, MD, PhD, SPAIN Irene Isabel López-Torres, MD, PhD, SPAIN Jm Arguello, MD, PhD, SPAIN David Sáez, MD, SPAIN Amaya Barberia, MD, SPAIN Emilio Calvo, MD, PhD, MBA, SPAIN
Variations In Branching Of Popliteal Artery And Its Clinical Interest Abstract Presentation 9 minutes Paloma Aragonés, MD, PhD, Prof., SPAIN Miguel Angel Hernan-Prado, MD, SPAIN Sara Quinones, MD, SPAIN Yolanda Guindal Pérez, PhD, SPAIN Ana María Valverde Villar, MD, SPAIN Irene Espina Flores , MD, SPAIN Jose R Sanudo, MD, PhD, Prof, SPAIN
Economic impact of anterior cruciate ligament injury in National Basketball Association players ePoster Presentation Nicholas J Vaudreuil, MD, UNITED STATES Carola F. van Eck, MD, PhD, FAAOS, UNITED STATES Daniel Daniel Kharrazi, MD, UNITED STATES
Management Of Acute Knee Dislocations: A Global Survey Of Orthopaedic Surgeons’ Strategies Abstract Presentation 6 minutes Santa-Marie Venter, MMED(Ortho), MSc, MBChB, LLB, BA, SOUTH AFRICA Roopam Dey, PhD, SOUTH AFRICA Vikas Khanduja, MA(Cantab), MBBS, MSc, FRCS, FRCS(Orth), PhD, UNITED KINGDOM Richard P. von Bormann, MD, SOUTH AFRICA Michael Held, MD, PhD, SOUTH AFRICA
Predictor Of Poor Pre-Operative Psychological Status In Cartilage Defect Patients Abstract Presentation 6 minutes David C. Flanigan, MD, UNITED STATES Alex C. Dibartola, MD, MPH, UNITED STATES Matthew Wiet, BS, UNITED STATES Joshua Scott Everhart, MD, MPH, UNITED STATES Robert A Magnussen, MD, MPH, UNITED STATES Laura C. Schmitt, PT, PhD, UNITED STATES Charles Emery, PhD, UNITED STATES
Arthroscopic-Assisted Robotic Bi-Unicompartmental Knee Arthroplasty: A Pilot Cadaveric Study. ePoster Presentation Andrea Fernandez, MD, FRANCE Elliot Sappey-Marinier, MD, FRANCE Frédéric Lavoie, MD, MSc, FRCSC, CANADA Cécile Batailler, MD, PhD, FRANCE Elvire Servien, MD, PhD, Prof., FRANCE Sebastien Lustig, MD, PhD, FRANCE
Increased MFC Width and Osteochondritis Dissecans: Cause or Effect and Implications for Osteochondral Allograft Transplantation ePoster Presentation Mitchell Scott Mologne, BS, UNITED STATES Timothy Mologne, MD, UNITED STATES Matthew T. Provencher, MD, UNITED STATES
Outcomes for Primary versus Revision Medial Patellofemoral Ligament Reconstruction with Concomitant Tibial Tubercle Osteotomy ePoster Presentation Elizabeth Rose Dennis, MD MS, UNITED STATES William A. Marmor, MD, UNITED STATES Simone Gruber, MS, UNITED STATES Joseph T. Nguyen, MPH, UNITED STATES Beth Ellen Shubin Stein, MD, UNITED STATES
The Application Of Continuous Passive Motion After Total Knee Arthroplasty Does Not Affect The Knee Motion, Postoperative Pain And Surgical Wound Aspect ePoster Presentation Sergi Gil Gonzalez, MD, SPAIN Ricardo Andrés Barja, MD, SPAIN Laura Valls, MD, SPAIN Hector Hormigó, MD, SPAIN Antonio Luis García Cebrián, MD, SPAIN Enrique Fernandez Bengoa, MD, SPAIN Antoni López Pujol, MD, SPAIN Juan Ignacio Erquicia, MD, PhD, SPAIN Xavier Pelfort, PhD, SPAIN Joan Leal-Blanquet, MD, PhD, SPAIN
Combining Sensor and Robotic Technologies to Balance Total Knee Arthroplasties Abstract Presentation 5 minutes Julien Bardou-Jacquet, MD, FRANCE Jérôme Murgier, MD, FRANCE François Laudet, MD, FRANCE
Side-To-Side Anterior Tibial Translation on Monopodal Weightbearing Radiographs as a Sign of Knee Decompensation in ACL Deficient Knees Abstract Presentation 5 minutes Luca Macchiarola, MD, ITALY jeremie Dor, MD, LUXEMBOURG Christophe Jacquet , MD, LUXEMBOURG Caroline Mouton, PhD, LUXEMBOURG Stefano Zaffagnini, MD, Prof., ITALY Romain Seil, MD, Prof., LUXEMBOURG
Low Complication And Redislocation Rates Are Evident Following Patellar Stabilization Surgery Abstract Presentation 6 minutes Laurie A. Hiemstra, MD, PhD, FRCSC, CANADA George Andrew Reed, BMSc, MD Candidate, CANADA Sarah Kerslake, BPhty, MSc, CANADA
Ultrasound-guided Injections and Arthroscopic Surgery as Treatment of Medial Plica Syndrome of the Knee ePoster Presentation Joyce van Heeswijk, MSc, NETHERLANDS Burt Klos, MD, PhD, NETHERLANDS Petra Heesterbeek, MSc, PhD, NETHERLANDS Stephan Konijnenberg, MD, PhD, NETHERLANDS
The Results Of 16S Dna Deep Sequencing In Culture-Negative Periprosthetic Joint Infections With Draining Sinus Tract Abstract Presentation 5 minutes Nicole Kennard, BS, MAT, UNITED STATES Arianna Mixon, BS, UNITED STATES Aniruth Srinivasaraghavan, BS, UNITED STATES Daniel Mohammadi, BS, UNITED STATES Gerhard E. Maale, MD, Prof., UNITED STATES
2 Year Outcomes of Lateral Meniscal Oblique Radial Tear (LMORT) Repair at the Time of ACL Reconstruction Surgery ePoster Presentation Erik Therrien, MD, MSc, FRCSC, CANADA Bryant M. Song, MS, UNITED STATES Ryan R Wilbur, BS, UNITED STATES Michael J. Stuart, MD, UNITED STATES Christopher L. Camp, MD, UNITED STATES Bruce A. Levy, MD, UNITED STATES Aaron J. Krych, MD, UNITED STATES
Bone-Patellar Tendon-Bone Anterior Cruciate Ligament Reconstruction Does Not Cause Functional Anterior Knee Pain ePoster Presentation Brian M Godshaw, MD, UNITED STATES Michael Nammour, MD, UNITED STATES Michael Warren, MD, UNITED STATES Colin Carroll, BS, UNITED STATES Misty Suri, MD, UNITED STATES
Lateral Hinge Fracture Risk Reduction In Medial Opening Wedge High Tibial Osteotomy: Where Should The Apex Be? A Laboratory Study Abstract Presentation 5 minutes Humza Tariq Osmani, BSc (Hons), MBBS (Dist), FRCS (Tr & Orth), UNITED KINGDOM Jaison Patel, BSc, MBBS, FRCS, UNITED KINGDOM Stas Tomaszczyk, BA, MEng, UNITED KINGDOM Michael Sutcliffe, MA, PhD, UNITED KINGDOM Joel Melton, BM, MRCS (Ed), MSc (Orth Eng), FRCS, UNITED KINGDOM
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ACL Repair Versus ACL Reconstruction in Chronic Lesions ePoster Presentation Gian Luigi Canata, MD, ITALY Valentina Casale, MD, ITALY
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Early Postoperative Results of the First Latin-American Experience with Robotic-Arm-Assisted TKA versus Conventional Technique Abstract Presentation 5 minutes David H. Figueroa, MD, CHILE Rodrigo Guiloff, MD, Prof, CHILE Tomas Prado, MD, CHILE Juan Jose Sotomayor, MD, CHILE Alberto Alarcon, MD, CHILE Alex Vaisman, MD, Prof., CHILE Rafael Calvo, MD, CHILE
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Adipose-Derived Culture-Expanded Mesenchymal Stem Cells Implantation for Focal Knee Lesions Improves Radiological and Clinical Outcomes Abstract Presentation 4 minutes Theofylaktos Kyriakidis, MD, MSc, PhD, GREECE Ioannes Melas, GREECE Efstathios Michalopoulos, PhD, GREECE Theophanis Chatzistamatiou, PhD, GREECE Michail I. Iosifidis, MD, PhD, GREECE
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Numbness around the replaced knee correlates with patient-reported outcome measures and kneeling Abstract Presentation 5 minutes Masafumi Itoh, MD, PhD, JAPAN Umit Kuwa, MD, PhD, JAPAN Junya Itou, MD, PhD, JAPAN Ken Okazaki, MD, PhD, JAPAN
Using the TTTG Measurement to Determine Surgical Management of Patellofemoral Instability ePoster Presentation Megan Diack, MBCHB, MRCSI, MCh, IRELAND Orla Hennessy, MB BaO BCh, MCh, IRELAND Diane Bergin, Prof., IRELAND Fintan J. Shannon, FRCS (Tr/Orth), IRELAND
Evaluating the Correlation Between Several Patellar Measurements and Patient’s Height and Weight - Matched Case-Control Study. ePoster Presentation Ahmad Essa, MPH MD, ISRAEL Dror Lindner, MD, ISRAEL Salah Khatib, MD, ISRAEL Gabriel Agar, Prof, ISRAEL Yiftah Beer, MD, ISRAEL
MPFL Reconstruction Using A Superficial Quadriceps Tendon Autograft Is Cost-effective Procedure and Offers Satisfactory Functional Results ePoster Presentation Saroj Rai, MD, PhD, UNITED ARAB EMIRATES Binod Sherchan, MS, NEPAL
Substantial Clinical Benefit In The Patient Reported Outcomes Following Primary Anterior Cruciate Ligament Reconstruction ePoster Presentation Youngsik Jeon, MD, KOREA, REPUBLIC OF Jihoon Bae, MD, PhD, KOREA, REPUBLIC OF Tae Jin Lee, MD, KOREA, REPUBLIC OF Taejin Kim, MD, KOREA, REPUBLIC OF
Changes in coronal alignment of the hip joint after Medial Opening High Tibial Osteotomy ePoster Presentation Jaison Patel, BSc, MBBS, FRCS, UNITED KINGDOM Reece Patel, BA, UNITED KINGDOM Joel Melton, BM, MRCS (Ed), MSc (Orth Eng), FRCS, UNITED KINGDOM
An Athletic State Of Mind; Not That Different Than The Non-Athletic State Of Mind ePoster Presentation David C. Flanigan, MD, UNITED STATES Alex C. Dibartola, MD, MPH, UNITED STATES Charles Emery, PhD, UNITED STATES Joshua Scott Everhart, MD, MPH, UNITED STATES Eric Milliron, BS, UNITED STATES Joshua Bowler, MD Laura C. Schmitt, PT, PhD, UNITED STATES Robert A Magnussen, MD, MPH, UNITED STATES
Analysis of poor clinical outcome after opening-wedge high tibial osteotomy over 65 years old ePoster Presentation Shuhei Otsuki, MD, JAPAN HItoshi Wakama, MD, JAPAN Yoshinori Okamoto, MD, PhD, JAPAN Masashi Neo, MD, PhD, Prof., JAPAN
CT Validation of Intraoperative Implant Position and Knee Alignment as Determined by the MAKO Total Knee Arthroplasty System ePoster Presentation Christopher J. Wilson, A/Prof, MBChB, MRCS, FRACS, PhD, AUSTRALIA James Sires, MD, AUSTRALIA
Our Experience In The Management Of Periprosthetic Fractures After Total Knee Arthroplasty With Revision Arthroplasty ePoster Presentation Celia Castillo, Resident, SPAIN Fernando Martín-Gorroño, Resident, SPAIN Marta García López, SPAIN Araceli Mena, Orthopaedic surgeon, SPAIN Víctor Vaquerizo García, MD, PhD, SPAIN
Outcomes of Medial Patellofemoral Ligament Reconstruction for Recurrent Patellar Instability in Patients with Ehlers-Danlos Syndrome Abstract Presentation 5 minutes James Nemunaitis, DO, UNITED STATES Shital N. Parikh, MD, UNITED STATES
Isolated Lateral Release For Chronic Patella Instability: Increased 5 Year Revision Rate As Compared To A Cohort Undergoing Medial Patellofemoral Reconstruction ePoster Presentation Adam Money, MD, UNITED STATES Seth L. Sherman, MD, UNITED STATES Kunal Varshneya, BS, UNITED STATES Andrew Gudeman, MD, UNITED STATES Kevin G. Shea, MD, UNITED STATES
Involvement Of Kaplan Fibers And Ilio-Tibial Band In The Control Of Anterolateral Rotational Knee Instability Abstract Presentation 4 minutes Thomas Neri, MD, PhD, Prof., FRANCE Antonio Klasan, MD, PhD, EMBA, FRCS, AUSTRIA Sven Edward Putnis, MB ChB FRCS(Tr&Orth), UNITED KINGDOM Rodolphe Testa, PhD, FRANCE Florian Bergandi, MD, FRANCE Alexandre Goimard, PT, FRANCE Remi Philippot, MD, PhD, Prof, FRANCE

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The Use Of Calcium Sulfate Hemihydrate As A Local Carrier For Antibiotics In The Treatment Or Prevention Of Orthopedic Infections

The Use Of Calcium Sulfate Hemihydrate As A Local Carrier For Antibiotics In The Treatment Or Prevention Of Orthopedic Infections

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The Use Of Calcium Sulfate Hemihydrate As A Local Carrier For Antibiotics In The Treatment Or Prevention Of Orthopedic Infections

The Use Of Calcium Sulfate Hemihydrate As A Local Carrier For Antibiotics In The Treatment Or Prevention Of Orthopedic Infections

Background

Methods

Results

Conclusion