Granulomatous Inguinal Lymphadenopathy After Bilateral Metatarsophalangeal Joint Silicone Arthroplasty

Silicone elastomer arthroplasties for joint diseases involv-ing the small joints of the hands and feet have been used worldwide since the late 1960s. While reports of axillary lymphadenopathy exist, the exact incidence of subclinical adenopathy and its relationship to arthroplasty integrity have been difficult to determine. We report a patient who developed bilateral inguinal granulomatous adenopathy as a foreign body response to regionally disseminated silicone particles from bilateral metatarsophalangeal joint prostheses. Silicone elastomer arthroplasty has been used to restore joint function and correct deformity in thou-sands of patients for the past two decades. " Compli-cations of silicone prosthetic implantation have included fracture and dislocation of implants, infection, and local foreign body synovitis. 1,5,14,15 Recently, silicone-induced granulomatous axillary lymphadenopathy has been re-ported in patients with finger joint arthroptastles.Y:" We report a patient who developed bilateral inguinal granulomatous adenopathy as a foreign body response to regionally disseminated silicone particles from bilat-eral metatarsophalangeal joint prostheses. CASE REPORT A 42-year-old white male football coach had bilateral first metatarsophalangeal joint replacements with sili-cone elastomer prostheses for severe hallux rigidus in 1980. He developed pain and swelling in the replaced joints after jogging 4 months after implantation. He therefore stopped jogging. Since then (1981) he has had no joint swelling or pain. In May 1984 he developed a single hard femoral lymph node which was excised and revealed foreign booy granulomas of undetermined etiology. Skin testing for tuberculosis was negative.