# Successful One-Stage Revision With Continuous Local Antibiotic Perfusion (CLAP) for Delayed Periprosthetic Joint Infection After Reverse Shoulder Arthroplasty: A Case Report

## TL;DR

A patient with a chronic shoulder infection after surgery was successfully treated with a one-step revision and continuous local antibiotic perfusion.

## Contribution

Demonstrates successful use of CLAP in treating multidrug-resistant periprosthetic joint infection after reverse shoulder arthroplasty.

## Key findings

- One-stage revision with CLAP resolved chronic PJI caused by ESBL-producing Klebsiella oxytoca and Staphylococcus aureus.
- Infection signs resolved rapidly, with no recurrence at one-year follow-up.
- The patient achieved functional shoulder motion and a JOA score of 69 post-treatment.

## Abstract

Periprosthetic joint infection (PJI) is a serious complication following reverse shoulder arthroplasty (RSA). We report a case of delayed PJI after RSA that was successfully treated with one-stage revision surgery combined with continuous local antibiotic perfusion (CLAP). A 72-year-old man with diabetes underwent RSA for cuff tear arthropathy at another hospital 21 months ago. Four months before presentation, he developed pain, swelling, warmth, and discharge from the surgical site, and PJI was diagnosed. Initial debridement, implant exchange, and antibiotic therapy were attempted at the previous hospital; however, the infection persisted, prompting a referral to our institution. On admission, wound drainage was observed; blood tests showed WBC 6,400/μL and C-reactive protein (CRP) 0.07 mg/dL. Culture identified extended-spectrum β-lactamase (ESBL)-producing Klebsiella oxytoca and Staphylococcus aureus. Plain radiography revealed osteolysis around both the glenoid and humeral components. A diagnosis of chronic PJI was made, and the patient underwent one-stage revision surgery with debridement, implant exchange, and CLAP therapy (gentamicin). Postoperative management included two weeks of negative pressure wound therapy (NPWT) with continuous gentamicin perfusion, followed by six weeks of intravenous antibiotics. Infection signs resolved rapidly, and at one year postoperatively, the patient showed no recurrence of infection without antibiotics. The active range of motion of the right shoulder at one year was as follows: forward flexion, 100°; abduction, 90°; external rotation, 10°; internal rotation to the sacrum; and JOA score, 69. This case highlights the potential role of CLAP as an adjunct to one-stage revision for shoulder PJI, even in infections caused by multidrug-resistant organisms.