Local antibiotic treatment for periprosthetic joint infection: current approaches and the emerging role of continuous local antibiotic perfusion.

PURPOSE: Periprosthetic joint infection (PJI) remains a major challenge in arthroplasty because biofilm-associated bacteria exhibit substantial antimicrobial tolerance. Local antimicrobial delivery can achieve high antimicrobial concentrations at the site of infection and has become an important adjunct to surgical treatment. This review summarizes current local antimicrobial strategies for PJI, with particular focus on continuous local antibiotic perfusion(CLAP), a novel approach developed in Japan that is used in combination with established surgical and systemic antimicrobial treatments. METHODS: The literature on local antimicrobial delivery for PJI was reviewed, focusing on the rationale, techniques, clinical applications, efficacy, and safety of CLAP. RESULTS: CLAP combines sustained high-concentration, low-flow antibiotic perfusion with continuous negative-pressure drainage. Intra-medullary, intra-articular, intra-soft tissue, and transpelvic regional antibiotic perfusion enable targeted antimicrobial delivery to infected bone, soft tissue, and joint spaces. Early clinical studies suggest that CLAP may improve implant retention when used as an adjunct to debridement, antibiotics, and implant retention and may also be used as an adjunct to one-stage and two-stage revision arthroplasty. Its application has further expanded to complex musculoskeletal infections, including pelvic osteomyelitis and fungal PJI. However, available evidence is predominantly based on case reports, small case series, and retrospective single-center studies, and standardized protocols have not been established. CONCLUSION: CLAP represents an emerging adjunctive treatment that complements, rather than replaces, established surgical treatment and systemic antimicrobial therapy by providing sustained high local antimicrobial exposure in PJI. Further high-quality studies are required to establish its efficacy, safety, optimal protocols, and role within contemporary PJI management.