title: 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.affiliation: Gaetano Pini Orthopaedic Institute, P.zza Cardinal Ferrari, 1, 20122, Milan, Italy, lmcpierannunzii@hotmail.com.
authors.forename: Luca
authors.initials: L
authors.lastname: Pierannunzii
authors.forename: Andrea
authors.initials: A
authors.lastname: Fossali
authors.forename: Orazio
authors.initials: O
authors.lastname: De Lucia
authors.forename: Arturo
authors.initials: A
authors.lastname: Guarino
mesh_terms: D000900:Anti-Bacterial Agents / Q000627:therapeutic use*; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D003646:Debridement / Q000379:methods*; D005260:Female; D005265:Femoral Neck Fractures / Q000601:surgery*; D006801:Humans; D008875:Middle Aged; D015207:Osteoarthritis, Hip / Q000601:surgery*; D016459:Prosthesis-Related Infections / Q000209:etiology* / Q000628:therapy; D013537:Sutures / Q000009:adverse effects*
chemical_list: D000900:Anti-Bacterial Agents