Table 1. Type of calcium sulphate derivatives used in the joints, incidence of wound drainage and management.
S/C: subcutaneous, G/A: general anaesthetic
| Author | Patients with Prosthetic Joint Procedures (N) | Calcium Sulphate Bead Derivative and Dosage | Space Calcium Sulphate Beads Used In | Wound Closure After Calcium Sulphate Insertion | Wound Leakage | Management of Wound Leakage |
| Sandiford [17] | 29 | Stimulan, 20–40 mL (mean: 25 mL) | Intracapsular compartment of hip joints, none in S/C tissue | Capsule closed over beads | 1/29 (3.4%) | Re-exploration under G/A + closure of soft tissue defect |
| Kallala and Haddad [18] | 15 | Stimulan, 10–40 mL | Around the hip/knee joints/prosthesis or spacer, none in S/C tissue | Wound closure methods not reported | 0/15 (0%) | N/A |
| Kallala et al. [19] | 755 | Stimulan, 5–80 cc (mean: 23.39 cc) | Knees – medial and lateral gutters | Wound closure methods not reported | 32/755 (4.2%) | Drainage >5 days post-operatively/serous/serosanguineous – wound redressed and anticoagulants stopped |
| Hips – placed deeply, inferior to the acetabulum and around the proximal femur | Drainage >5 days post-operatively/sanguineous discharge – washout under G/A | |||||
| McPherson et al. [20] | 250 | Stimulan, 5–50 cc | Knees – medial and lateral gutters, none in S/C tissue | Drain placed in the lateral gutter, wound closed in mid-flexion + - S/C drains | 3.2% overall | Lavage, debridement, wound VAC placement and/or compressive dressing |
| 3.5% knee wound drainage | ||||||
| Stimulan, 5–70 cc | Hips – deep hip space, inferior to the acetabulum and around the proximal femur, none placed in S/C tissue | Drain placed under TFL layer + - S/C drains, tension-free closure | 2.8% hip wound drainage | |||
| Menon et al. [21] | 3 | Stimulan (volume not reported specifically for PJI cases) | Not reported | Not reported for PJI | 1/3 wound patients had wound drainage | Re-exploration |
| Lum et al. [22] | 56 | Stimulan (volume not reported) | Not reported | Calcium sulphate beads placed into the wound during final closure | 1/56 (1.7%) | Resolved without surgical intervention |
| Agarwal et al. [23] | 4 | Stimulan (maximum volume: 20 cc) | Within the joint space and medullary canal | Not reported | 1/4 persistent culture negative discharge | Managed with regular dressing changes |