Primary Utilization of Bioabsorbable, Antibiotic-Loaded Calcium Sulphate Beads in Bacteremic Patients Undergoing Hip Hemiarthroplasty

Antibiotic-loaded calcium sulphate beads (ALCSB) have been effectively used in revision arthroplasty for prosthetic joint infections (PJI), but their use in primary arthroplasty as a prophylactic measure remains limited. This study presents the first reported experience using ALCSB in bacteremic patients undergoing hip hemiarthroplasty (HA) for displaced femoral neck fractures—a group at high risk for PJI. Four elderly patients (mean age 71.5) with confirmed preoperative bacteremia from various sources (pneumonia, infected ulcer, endocarditis) received ALCSB during HA. Beads were loaded with vancomycin and/or tobramycin based on microbial sensitivities and placed around the joint capsule and gluteal muscles. Over a mean follow-up of 18 months, none of the patients developed PJI, required revision, or experienced persistent wound drainage. One patient died postoperatively due to unrelated cardiac causes. The findings highlight the potential of ALCSB as a localized prophylactic strategy in high-risk HA patients, especially where systemic infection is present preoperatively. Although the sample size is limited, the absence of infection or wound complications supports the feasibility of this approach. Larger studies are needed to validate these findings and assess cost-effectiveness.