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Pyoderma Gangrenosum in Revision Total Hip Arthroplasty: Clinical and Histopathological Findings with a Seven-Year Follow-up

A Case Report

Burnett, R. Stephen J., MD, FRCSC1,a; Nair, Rajesh, BSc, MD2; Sawyer, Douglas M., MD, FRCPC4; Zbar, Ariella Z., BSc, MD3; Mathers, James W., BApplSc, MD3

doi: 10.2106/JBJS.CC.O.00067
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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.

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.

2Rebalance MD, Suite 104, 3551 Blanshard Street, Victoria, BC V8Z-0B9

3Island Medical Program, Medical Science Building, University of Victoria, P.O. Box 1700, STN CSC, Victoria, BC V8W-2Y2, Canada

4Department of Anatomic Pathology, University of British Columbia, Island Health, Royal Jubilee Hospital, 5th floor, 1952 Bay Street, Victoria, BC V8R-1J8, Canada

aE-mail address for R.S.J. Burnett: stephen.burnett@viha.ca

Copyright © 2015 by The Journal of Bone and Joint Surgery, Incorporated
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