Suture-related pseudoinfection after total hip arthroplasty.

Abstract

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.

• Authors: Luca Pierannunzii, Andrea Fossali, Orazio De Lucia, Arturo Guarino
• Journal: Journal of orthopaedics and traumatology : official journal of the Italian Society of Orthopaedics and Traumatology (J Orthop Traumatol) Vol. 16 Issue 1 Pg. 59-65 (Mar 2015) ISSN: 1590-9999 [Electronic] Italy
• PMID: 24916148 (Publication Type: Case Reports, Journal Article)

Chemical References

• Anti-Bacterial Agents

Topics

• Anti-Bacterial Agents (therapeutic use)
• Arthroplasty, Replacement, Hip (adverse effects)
• Debridement (methods)
• Female
• Femoral Neck Fractures (surgery)
• Humans
• Middle Aged
• Osteoarthritis, Hip (surgery)
• Prosthesis-Related Infections (etiology, therapy)
• Sutures (adverse effects)