Suspected Hypersensitivity Reaction to Titanium Screws Following Kalish Osteotomy for Hallux Valgus

Titanium implants are generally regarded as biocompatible and inert; however, hypersensitivity reactions, although uncommon, have been increasingly recognized in orthopedic surgery. We report a case of chronic inflammatory reaction following a Kalish osteotomy for hallux valgus, ultimately attributed to titanium hypersensitivity. A 58-year-old woman underwent fixation of the first metatarsal with two titanium screws. The postoperative course was complicated by wound dehiscence, delayed healing, recurrent granulomatous tissue, and persistent swelling, despite antibiotic therapy. Over the months, two additional surgical procedures were performed, including the removal of a floating bone fragment, followed by biopsy and complete hardware removal. Histopathologic analysis demonstrated reactive bone changes without signs of inflammation or infection, ruling out osteomyelitis. After the removal of the titanium screws, symptoms gradually resolved. At four-year follow-up, the patient remained pain-free with stable bone alignment. This case emphasizes the importance of recognizing titanium hypersensitivity as a potential cause of chronic sterile wound dehiscence and inflammation following orthopedic implant surgery.