Foreign-Body Reaction to Orthopedic Hardware a Decade After
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Cutaneous reactions to implantable devices, such as dental implants, intracoronary stents, prosthetic valves, endovascular prostheses, gynecologic devices, and spinal cord stimulator devices, occur with varying frequency and include infectious, hypersensitivity, allergic, and foreign-body reactions.

A 67 year old man presented with 2 painful nodules on the right clavicle that were present for several months. The patient denied fever, chills, weight loss, enlarged lymph nodes, or night sweats. Approximately 10 years prior to the appearance of the nodules, the patient fractured the right clavicle and underwent placement of a metal plate. His medical history included resection of the right tonsil and soft-palate carcinoma with radical neck dissection and postoperative radiation, which was completed approximately 4 years prior to placement of the metal plate. The patient recently completed 4 to 6 weeks of fluorouracil for shave biopsy–proven actinic keratosis overlying the entire irradiated area.

Physical examination revealed 2 pink friable nodules measuring 1.5 to 2.5 cm in diameter and leaking serous fluid within the irradiated area. The patient presented for excisional biopsy of these areas on the right medial clavicle 1 week later. Physical examination revealed the 2 nodules had decreased in diameter however, the patient had 4 discrete lesions measuring 4 to 7 mm in diameter, which were similar in appearance to the earlier nodules. He reported a low-grade fever, erythema, and increased tenderness of the area.

Underlying loosened orthopedic hardware screws were revealed upon punch biopsies of the involved areas. The CRP level was elevated, and the ESR was increased. The patient was admitted to the hospital, and antibiotics were started. Two days later, the orthopedic surgery service removed the hardware. At 3-week follow-up, physical examination revealed near closure of the wounds.

Cutaneous reactions to orthopedic implants include dermatitis, as well as urticarial, vasculitic, and bullous eruptions. Immune complex reactions can develop around implants, causing pain, inflammation, and loosening of hardware. Most inflammatory reactions take place within several months after implantation. Patient’s reaction to hardware 10 years after implantation highlights the importance of taking a detailed and thorough history that includes queries about distant surgery.