EVALUATION OF THE EFFICACY OF CONTINUOUS LOCAL ANTIBIOTIC PERFUSION (CLAP) FOR PERIPROSTHETIC JOINT INFECTION: CLAP VERSUS NON-CLAP

Aim Periprosthetic joint infection (PJI) is a serious complication that is difficult to treat and significantly affects patients’ functional prognosis and quality of life. I In Japan, continuous local antibiotic perfusion (CLAP) therapy, in which high-concentration antibiotics are administered directly to the infected area via a tube or needle, is widely used for musculoskeletal infections, and there have been many reports demonstrating its effectiveness. However, studies on its application in PJI remain limited. This study aims to compare treatment outcomes between PJI cases with and without CLAP intervention. Method We analyzed 65 PJI cases (29 TKA, 36 THA) that underwent surgery at our institution between April 2016 and July 2024, with at least six months of follow-up. Treatment success was defined as cases that did not require additional surgery for infection. Patients were classified into the CLAP group (n=17) and the non-CLAP group (n=48) based on the introduction period of CLAP (before September 2022: non-CLAP, after October 2022: CLAP). We also investigated the implementation of Debridement, Antibiotics, and Implant Retention (DAIR) and implant retention. Statistical analysis was conducted using the chi-square test and t-test. Results The CLAP group included 17 joints, while the non-CLAP group had 48 joints. There were no significant differences between groups regarding age, sex, BMI, timing from infection onset to surgery, timing from TJA surgery to infection onset, DAIR implementation, and implant retention. In terms of treatment success, the CLAP group had a significantly higher success rate in THA than the non-CLAP group (CLAP: 76.9%, non-CLAP: 34.8%, p=0.037). However, no significant difference was observed in TKA (CLAP: 75%, non-CLAP: 72%, p=1.0). Regarding case distribution, there was no significant difference in THA between primary (16 joints) and revision cases (20 joints) (p=0.614), whereas in TKA, primary cases (25 joints) were significantly more frequent than revision cases (4 joints) (p=0.002). Conclusions These results suggest that CLAP intervention may improve treatment outcomes in THA-associated PJI. In contrast, the high proportion of primary cases in TKA may have influenced treatment outcomes. Further accumulation of cases and long-term prognosis evaluation are needed for a more comprehensive analysis.