Late foreign-body reaction to PLLA screws used for fixation of acetabular osteotomy

Abstract

A 31-year-old woman underwent rotational acetabular osteotomy for acetabular dysplasia. At surgery, the acetabular fragment and the grafted bone were fixed with PLLA screws. One year 7 months after surgery, the patient returned to our clinic with acute swelling and pain with sinus formation. Based on the diagnosis of an infection, local debridement was performed. Histological examination of the debrided tissue revealed inflammatory cells; however no organism was found growing on the bacterial culture. During subsequent attempts to drain the lesion, we found small PLLA particles. Thus, we diagnosed the condition as a continued inflammatory process due to foreign-body reaction to the fragmented screw material. After a repeat debridement, the inflammation subsided. At the final follow-up two years after the last procedure, there was no recurrence and the patient had returned to regular activities. This report represents the first case of a severe local reaction to PLLA implants at and around the major joints.