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Novel Diagnostics in Revision Arthroplasty: Implant Sonication and Multiplex Polymerase Chain Reaction
Published on: December 3, 2017
Pyoderma Gangrenosum in Revision Total Hip Arthroplasty: Clinical and Histopathological Findings with a Seven-Year
R Stephen J Burnett1, Rajesh Nair2, Douglas M Sawyer3
1Department of Orthopaedic Surgery, University of British Columbia, Island Health, Royal Jubilee Hospital, Rebalance MD, Suite 104, 3551 Blanshard Street, Victoria, BC V8Z-0B9, Canada.
Case:
We describe the clinical and histopathological findings associated with a case of pyoderma gangrenosum (PG) after revision total hip arthroplasty. The patient developed an expanding purple-red, necrotic, ulcerative lesion at the surgical site, which was initially suspected to be either a surgical-site infection or warfarin-induced skin necrosis. After treatment with empiric intravenous antibiotics, surgical debridement, and vacuum-assisted closure of the wound, the patient had a painless hip with a remodeled scar and was asymptomatic at the seven-year follow-up.
Conclusion:
Confirmation of the diagnosis of surgical-site PG requires clinical-pathological correlation and familiarity with the PG skin lesion. Treatment of PG differs from treatment of infection; therefore, misdiagnosis and surgical treatment may exacerbate the clinical findings in PG.
