Absorbable
sutures are widely used for
wound closure after
total hip replacement. Here we present two cases of
suture-related
foreign-body reaction that perfectly mimicked a periprosthetic joint
infection, with sterile
abscess formation and physical and laboratory signs of
inflammation acutely presenting 7-8 weeks after surgery, at the time of
suture absorption. Both recurred with analogous timing after irrigation and
debridement, likely due to re-using the same
suture material. Multiple negative microbiological samples and positive histological samples showing a
foreign-body reaction are the fundamental steps towards the diagnosis of a
suture-related pseudoinfection (SRPI). Only three other cases have been reported to date, but the recurrence, together with the self-healing course after relapse, represents a completely novel feature and possibly the strongest demonstration of the supposed aetiopathogenesis. The knowledge of this possible complication leads to some clinical implications: all potential periprosthetic joint
infections should routinely undergo not only microbiological but also histological sampling; caution should be used when recommending
prosthesis exchange for potential
infections occurring in the time range of
suture absorption; lastly, if SRPI is suspected, a
suture with low propensity to induce
foreign-body reactions should be chosen after irrigation and
debridement and the volume of absorbable material left in the
wound should be as small as possible.