Does erysipelas-like rash after hip replacement exist?

Abstract

Background: Orthopaedic implants are known to rarely induce or exacerbate dermatitis in metal-allergic patients. In the late 1990s, hypersensitivity to prosthetic material has been suspected to induce recurrent aseptic localized cellulitis. Patients presented with recurrent eruption of the skin overlying the implant, associated with fever. An aseptic origin of this new syndrome was hypothesized as no evidence of microbial involvement could be found and because antibiotic treatment was apparently inefficient.

Observations: We observed 4 similar cases. All patients recovered after suppression of factors predisposing to erysipelas (gluteal portal of entry, anti-inflammatory drugs) and appropriate antibiotic therapy.

Discussion: Our conviction is that these manifestations are authentic infectious cellulitis. Delayed thigh erysipelas after hip surgery is a distinctive form of cellulitis, characterized by its unusual topography, its rapid outcome and the possibility to be recurrent.