Antibiotic-Loaded Calcium Sulphate Beads in Orthopaedic Infections: Clinical Outcomes of 166 Patients From a Tertiary Trauma Centre

Aim Orthopaedic infections including fracture-related infection, implant-associated infection, chronic osteomyelitis, and infected nonunion remain significant clinical challenges. Biofilm formation on implants and necrotic bone impairs antibiotic penetration and promotes infection persistence. Biodegradable antibiotic-loaded calcium sulphate beads offer sustained local antibiotic delivery and dead-space management, while eliminating the need for a second surgical procedure required with non-biodegradable carriers. This study aimed to evaluate the clinical outcomes of antibiotic-loaded calcium sulphate beads in the management of orthopaedic infections at a tertiary trauma centre. Methods A retrospective cohort study was performed, including 166 patients treated with antibiotic-loaded calcium sulphate beads for orthopaedic infections between 2015 and 2024. All patients underwent radical surgical debridement with removal of all necrotic tissue and intraoperative deep tissue sampling for microbiological culture. Calcium sulphate beads were prepared intraoperatively and loaded with antibiotics selected according to microbiological sensitivity profiles. All patients received adjunctive culture-guided systemic antibiotic therapy. The primary outcome was infection eradication, defined as absence of clinical, laboratory, and radiological signs of infection at final follow-up. Secondary outcomes included infection recurrence, wound-healing complications, and fracture union, where applicable. Results The cohort comprised 166 patients with a mean age of 46.2 years (Range between 13 – 81 yrs); 113 (68%) were male and 53 (32%) female. Chronic infections accounted for 121 cases (72.9%). Mean follow-up was 14 months. Infection eradication was achieved in 155 patients (93.4%). Persistent infection occurred in 11 patients (6.6%). Infection recurrence was observed in 18 patients (10.8%). Wound-healing complications were recorded in 14 patients (8.4%), most of whom were managed conservatively. No systemic adverse events attributable to local antibiotic delivery were identified. Conclusions Antibiotic-loaded calcium sulphate beads provide an effective adjunct for local antibiotic delivery and dead-space management in orthopaedic infections. An infection eradication rate exceeding 93% was achieved in this heterogeneous cohort, consistent with previously published literature. The biodegradable nature of the carrier eliminates the requirement for planned implant removal. These results support the use of calcium sulphate beads as part of a comprehensive surgical strategy incorporating radical debridement and culture-guided systemic antibiotics. These findings support the routine incorporation of biodegradable antibiotic-loaded calcium sulphate beads into the surgical management of orthopaedic infections, particularly in the context of dead-space management following radical debridement.”