Outcomes and safety of antibiotic-loaded calcium sulfate beads in orthopaedics: A systematic review and meta-analysis

Introduction: Calcium sulfate (CS) has emerged as a local antibiotic delivery system, offering biodegradability, osteoconductive properties and sustained antibiotic release. The aim was to evaluate the clinical outcomes and safety of antibiotic-loaded CS beads as an adjunct in the management and prevention of orthopaedic infections. Methods: statistic. Results: = 87%). Wound-related complications were documented in 17% (189/1086) of osteomyelitis cases, compared to 8% (23/277) of PJI cases. PJI treatment was associated with minimal complications, including 12 cases of hypercalcemia (12/277, 4%) and nine cases of heterotopic ossification (9/262, 3%). Conclusion: Current evidence describes favorable infection eradication rates when antibiotic-loaded CS beads are used as an adjunct in orthopaedic infection management and prevention, but the absence of comparative trials precludes conclusions regarding independent efficacy. All studies showed complete CS resorption. Wound-related complications were substantial in osteomyelitis cases, while other adverse events were rare. Higher-quality comparative studies are required before routine adoption.