Successful Prosthesis Salvage Using Continuous Local Antibiotic Perfusion (CLAP) for Prosthetic Joint Infection Following Revision Total Elbow Arthroplasty in a Patient with Rheumatoid Arthritis: A Case Report

INTRODUCTION: Prosthetic joint infection (PJI) represents a serious and challenging complication in a patient with rheumatoid arthritis (RA). We report a case of PJI following revision total elbow arthroplasty (TEA) with RA that was successfully managed with debridement, antibiotics, and implant retention (DAIR) augmented by continuous local antibiotic perfusion (CLAP). CASE PRESENTATION: A 69-year-old woman with a 39-year history of RA previously underwent revision TEA for aseptic loosening. Two years following the revision surgery, she developed left elbow swelling, pain, and erythema, resulting in a diagnosis of PJI. Because the implant remained stable without evidence of loosening, an emergency DAIR procedure was performed in conjunction with CLAP in attempt to salvage the prosthesis. Intraoperative cultures were positive for methicillin-susceptible Staphylococcus aureus. Following surgery, the patient received targeted systemic antibiotic therapy alongside continuous local gentamicin perfusion via CLAP system. Local perfusion was discontinued on postoperative day 18, and oral antibiotic suppressive therapy was continued for three months. At the two-year follow-up examination, the patient showed no clinical evidence of recurrent infection and had maintained her preoperative elbow range of motion. CONCLUSION: The integration of CLAP with the DAIR procedure represents a promising, prosthesis-preserving therapeutic strategy for managing PJI following revision TEA.