Iatrogenic Hypercalcaemia Secondary to Antibiotic-Eluting Absorbable Calcium-Sulphate Beads in Orthopaedic Surgery

Calcium-sulphate beads (CSBs) are increasingly used to manage surgical site infections, serving both as local antibiotic carriers and as fillers for dead space. Although generally well tolerated, hypercalcaemia has been described as a serious adverse effect. In this case report, we describe a patient who developed symptomatic hypercalcaemia secondary to using CSBs during a proximal femoral excision (Girdlestone procedure). This study describes an 86-year-old woman who developed decreased consciousness and altered neurological status four days post a Girdlestone procedure with placement of 20 cc of antibiotic-eluting CSBs. She was afebrile with normal cardiovascular, respiratory, and abdominal examinations but exhibited abnormal neurological findings, responding only to painful stimuli. Laboratory results revealed severe hypercalcaemia. She had no past medical history of malignancy, parathyroid, or calcium disorders. She was subsequently treated with IV fluids and an IV zoledronic acid infusion. Over the following week, her clinical status improved and hypercalcaemia resolved. This case highlights that significant hypercalcaemia can still occur outside the traditionally recognised risk factors, emphasising the need for vigilance even in lower-risk patients.