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BACKGROUND: We investigated a skin adhesive closure device consisting of a self-adhesive polyester mesh placed over the surgical incision, followed by a liquid adhesive that is spread over the mesh and surrounding the skin. It is intended to reduce wound closure times, scarring, and skin complications associated with traditional closure with sutures or staples. The aim of this study was to report on skin reactions in patients who underwent primary total knee arthroplasty (TKA) using the skin adhesive closure system. METHODS: A retrospective review of patients who underwent TKA using adhesive closure between 2016 to 2021 at a single institute was performed. A total of 1,719 cases were analyzed. Patient demographics were collected. The primary outcome was any postoperative skin reaction. Skin reactions were classified as allergic dermatitis, cellulitis, or other. Treatment(s), duration of symptoms, and surgical infections were also collected. RESULTS: A total of 5.0% (86) of patients were found to have any type of skin reaction following their TKA. Of these 86, 39 (2.3%) had symptoms of allergic dermatitis (AD), 23 (1.3%) had symptoms of cellulitis, and 24 (1.4%) had other symptoms. A total of 27 (69%) allergic dermatitis patients were treated with a topical corticosteroid cream only; their symptoms resolved within an average of 25 days. There was only 1 case of superficial infection (<0.001%). No prosthetic joint infections were observed. CONCLUSION: Despite skin reactions appearing in 5.0% of cases, the rate of infection was low. A patient-specific preoperative workup and effective treatment strategies can minimize complications associated with adhesive closure system and increase patient satisfaction following TKA.

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A 64-year-old male with a recalled modular-neck stem implant presented with a soft tissue mass in the lateral thigh. Preoperative testing revealed no signs of infection by the 2018 periprosthetic joint infection criteria. MRI revealed a large soft tissue mass around the implant consistent with a pseudotumor, and we performed revision surgery of the femoral component for trunnionosis. One intraoperative culture was positive for infection, and the patient was placed on antibiotics. Six weeks following revision surgery of the femoral component, the patient presented with acute drainage and was diagnosed with an acute on chronic periprosthetic joint infection and underwent explantation of the femoral and acetabular components with the placement of an antibiotic spacer. Cultures revealed identical bacteria from the index procedure. Given the clinical course, this case likely represents adverse local tissue reaction with an atypical presentation of periprosthetic joint infection. This is the first case presentation of an adverse local tissue reaction and superimposed periprosthetic joint infection with normal infection workup, representing an important consideration when differentiating between pseudotumor and periprosthetic joint infection in modular-neck femoral stem implants.

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