Successful implant salvage of a delayed tibial megaprosthesis infection using continuous local antibiotic perfusion: a case report

Introduction: Postoperative infection following megaprosthetic reconstruction is a challenging complication due to extensive metallic surfaces, poor vascularity, and biofilm formation. We report a rare case of delayed tibial megaprosthetic infection managed using continuous local antibiotic perfusion (CLAP). Case presentation: A 22-year-old male previously underwent wide resection and tibial megaprosthetic reconstruction for osteosarcoma and developed chronic osteomyelitis 2 years after revision surgery. CLAP was performed using intramedullary and subcutaneous double-lumen catheters combined with negative-pressure wound therapy. Cutibacterium acnes was identified intraoperatively. Systemic minocycline and clindamycin were administered. Infection control was achieved without implant removal, with normalization of inflammatory marker levels and radiographic improvements. The Musculoskeletal Tumor Society functional score improved from 70% to 90%, and no recurrence or loosening was observed after 1 year. Clinical discussion: Megaprosthetic infections are particularly difficult to manage because of implant surfaces, dead space, and poor local vascularity. This case demonstrates that CLAP may provide an effective limb-sparing strategy for infection control while preserving the implant. The key advantage of CLAP is its capacity to deliver high concentrations of antibiotics directly to infected bone and surrounding soft tissues, even in poorly vascularized regions, allowing sustained bactericidal activity against biofilm-embedded bacteria. The successful eradication of C. acnes infection in this case suggests that CLAP may be a promising strategy for managing indolent biofilm-associated infections. Conclusion: Given the complexity and limited vascularity associated with megaprosthetic reconstructions, CLAP represents a promising adjunctive strategy for managing difficult implant-related infections, as demonstrated in this rare case of delayed tibial megaprosthesis infection.