Authors: Ngozika Martha Chidiobi , Rohan Dahiya , Salman Qayum , Jane Edmondson , Aditya Maney

Abstract

Background: Calcium sulfate beads are frequently used in the management of periprosthetic joint infections (PJIs) because of their effectiveness in local antibiotic delivery and bone void filling. However, repeated use can lead to significant complications, including iatrogenic hypercalcemia. Despite reports of this complication in the literature, the cases in this paper demonstrate a relative lack of awareness among physicians.
Cases: We report two cases of iatrogenic hypercalcemia secondary to repeated administration of calcium sulfate beads in the treatment of femoral PJIs, a cause that was initially unrecognized by the medical team.
Case 1: An 83-year-old woman developed severe hypercalcemia requiring intensive medical management following multiple surgeries for chronic femoral PJI that necessitated implantation of calcium beads for antibiotic delivery.
Case 2: An 81-year-old woman developed recurrent hypercalcemia after multiple administrations of calcium sulfate beads for treatment of her periprosthetic fracture.
Conclusion: These cases highlight the potential risk of hypercalcemia associated with the use of calcium sulfate beads and emphasize the need for careful monitoring of serum calcium levels in such patients. They underscore the importance of multidisciplinary collaboration, which was instrumental in determining the etiology in these cases.

Keywords: Iatrogenic hypercalcemia, Calcium sulfate, prosthetic joint infection (PJI), biofilm, arthroplasty, case report.