Clinical outcomes of continuous local antibiotic perfusion in combination with debridement antibiotics and implant retention for periprosthetic hip joint infection

Periprosthetic joint infection (PJI) is a complication of peri-implant biofilm-based treatments and confers resistance to antimicrobial therapy. Integrating continuous local antibiotic perfusion (CLAP) with conventional surgery for PJI facilitates the local delivery of low-flow, high-concentration antimicrobials. This study aimed to evaluate the efficacy and safety of CLAP for treating PJI. This study included patients diagnosed with hip PJI who underwent debridement, antibiotics, and implant retention (DAIR) augmented by CLAP. Gentamicin was administered at a high concentration (1.2 mg/mL) and low flow rate (2.0 mL/h for 24 h). We evaluated implant survival and complication rates associated with adding CLAP to conventional DAIR surgery. Of the 22 patients, including 11 with chronic infection, DAIR surgery supplemented with CLAP resulted in implant survival in 20 patients (90.9%). In contrast, among 10 patients treated with DAIR without CLAP (non-CLAP group), implant survival was 70%. The mean follow-up period was 42.6 +/- 31.5 (range, 12-161) months in the CLAP group and 56.8 +/- 28.8 (range, 28-114) months in the non-CLAP group. During CLAP treatment, renal function worsened in two patients; however, it improved rapidly after CLAP completion and device removal. No major complications were observed. CLAP demonstrated promising results in treating acute and chronic PJI. However, monitoring and regulating blood antimicrobial levels is crucial to avoiding renal dysfunction. CLAP is a treatment option for PJI that can destroy bacterial biofilms.