Inguinal lymph node foreign body granulomas after placement of a silicone rubber (Silflex®) implant of the first metatarsophalangeal joint

We describe a woman who developed foreign body granulomas 8 years after metatarsophalangeal (MTP) joint silicone rubber implantation for hallux rigidus. She developed overnight swelling and tenderness in the inguinal region on the ipsilateral side. Histological evaluation of the lymph node showed foreign body granulomas. Electron microscopy and dispersion x-ray analysis identified the foreign body material in the inguinal lymph node and fibrous capsule surrounding the implant as silicone. Foreign body granulomas of surrounding tissues and regional lymph nodes are infrequently reported postoperative complications in patients with small joint silicone rubber implants. A fractured or eroded implant surface attributed to wear is usually noted at prosthesis excision. Granulomas in normal or enlarged lymph nodes have been described in both symptomatic and asymptomatic patients, with intact or fractured prostheses. Many related joint and lymph node symptoms resolve with removal of the silicone rubber prosthesis.