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Case Reports
. 2025 Aug 3;17(8):e89280.
doi: 10.7759/cureus.89280. eCollection 2025 Aug.

When Sutures Fail: Extrusion of an Inspire Device and a Hip Prosthesis in the Same Patient

Kalin R Sorenson  1 , Cameron Robins  1 , Keala Verigan  2 , Nicholas Gerber  2 , Louis Musso  2
Affiliations
Case Reports

When Sutures Fail: Extrusion of an Inspire Device and a Hip Prosthesis in the Same Patient

Kalin R Sorenson et al. Cureus. .

Abstract

Implant extrusion is a rare but serious complication typically linked to infection, poor wound healing, or material intolerance. This case report describes a 79-year-old female patient who experienced extrusion of both a hip prosthesis and an Inspire hypoglossal nerve stimulator (Inspire Medical Systems, Inc., Minnesota, USA), each event associated with the use of Ethibond (Ethicon, Johnson & Johnson, Georgia, USA) sutures. The patient had a history of obstructive sleep apnea refractory to continuous positive airway pressure (CPAP) therapy and underwent Inspire device implantation. Postoperatively, she developed a sterile fluid collection and wound dehiscence, leading to visible extrusion of the device. Notably, she had previously experienced a near extrusion of a hip prosthesis, also linked to Ethibond. In both cases, the infectious workup was negative. Following explantation and reimplantation of the Inspire device using Monocryl and Prolene sutures (both by Ethicon, Johnson & Johnson, Georgia, USA) and the application of a dermal graft, the patient achieved successful healing without recurrence. This case underscores the importance of considering suture-related foreign body reactions in patients with recurrent implant extrusion and no evidence of infection. Surgeons should remain vigilant in selecting suture materials, especially in patients with a history of adverse reactions, and future research should explore suture-tissue interactions to guide safer implant practices.

Keywords: ethibond; hip prosthesis; implant extrusion; inspire device; suture hypersensitivity.

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Conflict of interest statement

Human subjects: Informed consent for treatment and open access publication was obtained or waived by all participants in this study. Rocky Vista University Institutional Review Board issued approval 2025-067. Conflicts of interest: In compliance with the ICMJE uniform disclosure form, all authors declare the following: Payment/services info: All authors have declared that no financial support was received from any organization for the submitted work. Financial relationships: All authors have declared that they have no financial relationships at present or within the previous three years with any organizations that might have an interest in the submitted work. Other relationships: All authors have declared that there are no other relationships or activities that could appear to have influenced the submitted work.

Figures

Figure 1
Figure 1. A timeline starting from when the patient first presented to the clinic for her sleep apnea to the most recent postoperative condition
Figure 2
Figure 2. A depiction of the sequence of T-cell activation from an APC that can lead to an extrusion, as in this case, or scarring
APC: Antigen-presenting cell. Figure created with BioRender.com. Used with permission under an academic subscription.
See this image and copyright information in PMC

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