Continuous Local Antibiotic Perfusion for Periprosthetic Joint Infection After Tumor Endoprosthetic Reconstruction

Periprosthetic joint infection (PJI) after tumor endoprosthetic reconstruction is a devastating complication associated with substantial morbidity. Infection rates are considerably higher than those reported after conventional arthroplasty, and implant removal often leads to major functional impairment, complex revision surgery, or even amputation. Therefore, treatment strategies that achieve infection control while preserving the implant are critically important in this patient population. Continuous local antibiotic perfusion (CLAP) is a recently introduced technique that enables sustained delivery of high local antibiotic concentrations directly to the infected site. However, its role in managing PJI after tumor endoprosthetic reconstruction remains unclear.

We conducted a retrospective case series of three patients with PJI after tumor endoprosthetic reconstruction who were treated with CLAP at our institution. All patients underwent surgical debridement followed by placement of local perfusion tubes for continuous antibiotic delivery combined with systemic antibiotic therapy. Clinical characteristics, treatment details, complications, and infection-related outcomes were evaluated. All three patients successfully completed a 14-day course of CLAP. Infection control was achieved without implant removal in all cases. No major CLAP-related complications occurred during a follow-up ranging from 2 to 22 months. One patient required two sequential CLAP procedures to achieve infection control. Systemic toxicity related to local antibiotic administration was not observed, except for a transient increase in serum gentamicin levels in one case, which normalized after dose adjustment.

In this small case series, CLAP enabled infection control with implant retention in patients with PJI after tumor endoprosthetic reconstruction. Given the high morbidity associated with these infections and the importance of limb preservation and continuation of oncologic therapy, CLAP may represent a promising implant-preserving treatment strategy in this challenging clinical setting.