Severe Hypercalcemia Following Hip Joint Implantation of Calcium Sulfate Antibiotic Beads: Case Series and Review of Literature.

Purpose: The diagnosis and management of hypercalcemia in hospitalized patients can be challenging. Hypercalcemia is often associated with significant morbidity and end-organ damage which may delay a patient's recovery.

Methods: We report a case series of three patients who underwent orthopedic procedures with intraoperative placement of vancomycin-loaded calcium sulfate beads. Patients had no known history of malignancy or excess intake of calcium, vitamin A or vitamin D. Laboratory workup showed low parathyroid (PTH) levels and normal PTH-related peptide levels. The temporal nature of the non-PTH mediated hypercalcemia in relation to implantation of the antibiotic beads suggests causality of exogenous calcium sulfate with the patients' subsequent hypercalcemia.

Results: Patients were treated with aggressive intravenous saline and zoledronic acid resulting in resolution of hypercalcemia in all cases. The antibiotic impregnated beads did not require explantation.

Conclusion: Hypercalcemia following calcium sulfate antibiotic bead implantation may contribute to patient morbidity and increased length-of-stay. We recommend serum calcium and creatinine be closely monitored during the early postoperative period in patients who receive calcium sulfate antibiotic beads.