A Novel Case of Hypercalcemia Following the Use of Calcium Sulfate Beads

Abstract

The patient’s consent for clinical history and x-rays has been obtained for the purposes of publication. A 72-year-old Caucasian female had an initial right Total Hip Arthroplasty
(THA) on April 21st, 2014 (using an 11 mm high offset Taperloc Complete stemTM, 50 mm
Tri-Spike acetabulumTM, 44 mm E-poly active articulation and 28 mm ceramic head) due to
degenerative osteoarthritis, with operative findings of eburnated bone and severe arthofibrosis
of the hip. On May 29th, 2014, she represented to the Emergency Room with severe pain in
the right hip, redness along the surgical site; low grade fever (37.5 ºC) and mild leukocytosis
(white blood cell (WBC) count 11 K/µL) with neutrophilia (82.8%). Initial blood cultures demonstrated no growth. She underwent a revision with a Biomet® 50 mm polyethylene Freedom
acetabulumTM, 36 mm head Freedom headTM with ultra-high dose antibiotic mixture. Intraoperatively, she was found to have purulent fluid throughout the hip and subsequently grew Methicillin-resistant Staphylococcus aureus. She had recurrence of severe pain in early August 2014
and was again readmitted on August 18th, 2014, found to have leukocytosis (WBC, 17.8 K/µL)
where she underwent a second revision that involved the use of a 56 mm Regenerex acetabulumTM and 190 mm Arcos STS stemTM, placed due to the previous stem. There was in duration,
erythema but no obvious purulence during this procedure and subsequent cultures did not show
evidence of growth. Three screws were placed for additional fixation. Antibiotic impregnated
calcium sulfate beads (AICBs), using OsteosetTM beads, in this case with 2 g of Vancomycin
and 3.6 g of Tobramycin, prepared by the hospital pharmacy department per company issued
instructions, were implanted around and medial to the prosthesis and hip joint (Figure 1). Her
post-operative course was initially complicated by Coombs positive hemolytic anemia, with a
drop in hemoglobin to 4.7 g/dL for which she required several blood transfusions.