Allergic Contact Dermatitis to 2-Octyl Cyanoacrylate After Total Joint Arthroplasty: A Single-Surgeon Case Series.

Background: 2-Octyl cyanoacrylate is widely used for surgical skin closure in orthopaedic procedures, offering advantages such as ease of application, strong adherence, and favorable cosmetic outcomes. However, allergic contact dermatitis (ACD) is a rare yet recognized complication resulting in topical and systemic treatments and a theoretical risk for superficial and deep periprosthetic joint infection (PJI). Methods: This retrospective case series analyzes patients who developed hypersensitivity reactions to 2-octyl cyanoacrylate following primary hip and knee arthroplasty performed by a single surgeon between 2017 and 2024. Only cases with photo documentation and a minimum of 6 weeks follow-up were included. Results: We identified 2,789 (total hip arthroplasty = 1270, total knee arthroplasty = 1516) hip and knee arthroplasty procedures utilizing 2-octyl cyanoacrylate. Among these, 15 patients (0.54%) developed ACD (6 after hip and 9 after knee arthroplasties). The mean onset time was 11.7 days; average resolution occurred at 27.4 days. All cases were managed conservatively with topical and oral therapies. No PJIs or reoperations occurred. Wounds achieved excellent cosmesis with only one patient with persistent skin discoloration. Conclusions: ACD due to 2-octyl cyanoacrylate skin glue is uncommon and generally self-limiting when appropriately diagnosed and managed and does not go on to superficial or deep PJI. Surgeons should be aware of this complication and educate patients to facilitate early identification and treatment. Hypoallergenic alternatives may be considered in future elective orthopaedic surgery; however, comparative products must also achieve the exceptional safety profile of 2-octyl cyanoacrylate in regard to superficial or deep PJI. Level of Evidence: Level IV, Case Series.