Allergic or Hypersensitivity Reactions to Orthopaedic Implants

Roberts, Timothy T.; Haines, Colin M.; Uhl, Richard L.

doi:10.5435/jaaos-d-16-00007

Cited by 34 publications

(35 citation statements)

References 42 publications

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“…Beside infections, other implant‐related complications such as malalignment, loosening, skin changes, pain and swelling may occur. One potential cause that has been widely discussed is a hypersensitivity reaction to a metal or bone cement component . According to case reports, allergic reactions to such materials have been rarely described .…”

Section: Introductionmentioning

confidence: 99%

“…One potential cause that has been widely discussed is a hypersensitivity reaction to a metal or bone cement component. [6][7][8][9][10][11][12][13][14][15] According to case reports, allergic reactions to such materials have been rarely described. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Larger studies evaluated potential allergens and hypersensitivity prevalences after TJA, and tried to establish general preoperative (PO) and postoperative guidelines in cases of suspected metal hypersensitivity.…”

Section: Introductionmentioning

confidence: 99%

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Metal hypersensitivity in patients with orthopaedic implant complications—A retrospective clinical study

et al. 2018

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Background Hypersensitivity to metals as a cause of implant‐related complications has been a subject of controversy. Projections indicate an increase in the frequency of joint replacements of between 300% and 600% by the year 2030; therefore, this issue is of considerable interest. Objective To evaluate sensitization to implant materials in patients with implant‐related complications, to identify allergens, and to clarify whether hypersensitivity is a relevant cause. Methods Patients with implant‐related complications or a positive history of contact allergy and planned total joint replacements referred for allergological investigation between 2004 and 2017 were retrospectively analysed. Results In total, 311 patients were included. A positive patch test reaction to a metal was seen in 64.4% of preoperative patients and in 54.6% of patients with implant‐related complications. Common alloy metals such as cobalt, chromium and titanium gave positive reactions in up to 2.9% of patients with implant‐related complications. None of the patients with skin changes had a positive patch test reaction to an implant metal. Conclusion Other factors, such as the type of replaced joint and mechanical stress, seem to be more relevant for implant‐related complications. Sensitization to metals or other materials seems to rarely play a role, and is overestimated.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Metal hypersensitivity in patients with orthopaedic implant complications—A retrospective clinical study

et al. 2018

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“…Tablo 2'de, ortopedide sık kullanılan metallerin elemental kompozisyonları ve biyolojik reaktivitelerinin karşılaştırması yer almaktadır. [7] Şekil 1. Diz eklem protezinin metalik patellar komponentinde meydana gelen aşınma.…”

Section: İmplante Materyale Karşi Oluşan Kli̇ni̇k Reaksi̇yonlarunclassified

“…Tablo 2. Sık kullanılan ortopedik materyallerin elemental yapısı ve karşılaştırmalı biyolojik reaktiviteleri [7] Ortopedik Metal İmmünojenite…”

Section: İmplante Materyale Karşi Oluşan Kli̇ni̇k Reaksi̇yonlarunclassified

Metal duyarlılığı ve metalloz

Günsen¹,

Sin²

2019

TOTBID

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zamanla daha öncesinde farkında olunmayan sorunlarla karşılaşılmasına yol açmıştır. Kullanılan metal materyallerin neden olabileceği duyarlılık ve alerji, son on yıldır giderek artan şekilde hekimlerin ilgisini çekmektedir.Toplumda metal duyarlılığı sık görülen bir sorundur. Genel popülasyonun %10-15'inde metallere karşı reaksiyonlar, ciltte görülür. Klinik pratikte en sık nikele karşı duyarlılık ile karşılaşılır. Paslanmaz çeliğin önemli bir bileşeni olan nikel içerikli maddelerin günlük yaşamda çok sık kullanılması ve bu nedenle sık temas edilmesi, bu durumun en önemli nedenidir. Yapılan toplum temelli çalışmalarda, nikel duyarlılığı %10-19 gibi yüksek oranlarda saptanmaktadır. Nikelden sonra alerjenik olan iki metal kobalt ve kromdur. [1,2] İ nsan vücudunda metallerden üretilmiş tedavi araçları yüz yılı aşkın bir süredir kullanılmakta; uygulamaların sayısı ve uygulanan tıp dalları giderek artmaktadır. Sert materyal kullanımına daha uygun olduğu düşünülen kas-iskelet sisteminden başlayan bu uygulamalar, bugün hemen her sisteme yayılmıştır. Metaller insan vücudunda genellikle biyolojik uyum sorununa yol açmadıklarından, başta ortopedi olmak üzere, jinekoloji, kardiyovasküler cerrahi, otorinolaringoloji, nöroşirürji ve diş hekimliğinde sıklıkla kullanılmaktadır. Değişik tiplerdeki plaklar, vidalar, eklem protezleri, tel ve çiviler, sütür materyalleri, stentler ve diş dolgularında metal yapılar bulunur. Metallerin insan vücuduna kalıcı olarak yerleştirilmesi, gerektiğinde onlardan hareketli olacak şekilde de yararlanılması, Metal duyarlılığı ve metallozHypersensitivity to orthopaedic implants and metallosis * Bu makale genç yaşta en verimli çağında aramızdan ayrılan Uzman Doktor Fatma Düşünür Günsen'nin aziz anısına ithaf olunmuştur.Metal hipersensitivitesi, özellikle nikel duyarlılığı toplumda sık görülen bir durumdur. İmplante metaller biyolojik sıvılarla temas ettiğinde aşınır ve demir, krom, nikel, alüminyum ve molibden gibi metalik iyonlar salınır. Bu metal iyonları lokal veya sistemik etkilerle hipersensitivite reaksiyonlarına neden olabilir. İmplante materyale karşı gelişen reaksiyonlardan "T-hücre aracılı Tip IV, geç tip hipersensitivite yanıtı" sorumludur. Yama testi metal duyarlılığını göstermede altın standarttır. Rutin olarak operasyon öncesi yama testi önerilmemektedir. Hastanın öyküsünde kişisel metal duyarlılığı öyküsü var ise yapılmalıdır. Hastaların ameliyat öncesi değerlendirmesi sırasında kimin hipersensitivite reaksiyonu geliştireceğini önceden belirleyen bir test yöntemi yoktur. Metal hipersensitivitesi; psödotümör formasyonuna, kronik ağrıya, eklem effüzyonuna hatta protez başarısızlığına ve değiştirilmesine neden olabileceğinden, ortopedide önemli bir sorundur.Anahtar sözcükler: metal duyarlılığı; ortopedik implantlar; alerji Sensitivity to metals is very common, especially to nickel. Implanted metals corrode when in contact with biological fluids and release metallic ions of iron, chromium, nickel, aluminum, molybdenum etc. These metal ions may cause local or systemic effects and induce hyp...

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“…Total knee replacement for patients with allergies to orthopedic materials requires low wear rate against polyethylene, no release of metal ions and particles from the implant, and fixation of the implant to the bone surface without poly(methyl methacrylate) (PMMA) cement. Magnesia‐stabilized zirconia (Mg‐PSZ) is a hard‐ceramic material that has been shown to cause less polyethylene wear in total hip and knee wear simulator tests, compared to cobalt chromium alloy (CoCr) bearing surfaces.…”

Section: Introductionmentioning

confidence: 99%

Enhanced adhesion of plasma‐sprayed commercially pure titanium porous coatings to polished Mg‐PSZ ceramic substrates

Tilden

Roy

Whiteside

2019

J Biomedical Materials Res

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The purpose of this study was to evaluate the suitability of a plasma sprayed titanium porous coating on polished magnesia‐stabilized zirconia (Mg‐PSZ) ceramic surfaces. We hypothesized that diffusion bonding was responsible for the adhesion of the coating to the ceramic substrate. Mg‐PSZ tensile test coupons were vibratory polished (roughness Sa = 0.50 μm) or vibratory polished/lapped (Sa = 0.12 μm) before coating and testing. The exposed surfaces after tensile testing were examined by energy dispersive X‐ray (EDX) analysis. Mg‐PSZ shear test coupons were vibratory polished (Sa = 0.48 μm). As the surface roughness of the ceramic substrate decreased by a factor of 4.175, the coating tensile strength increased from 62.6 to 66.8 MPa, comparable to that of porous coated cobalt chromium (CoCr) and titanium (Ti‐6Al‐4V) coupons. EDX analyses found titanium everywhere on the ceramic surface after the titanium layer was pulled off with tensile testing, even on areas that appeared to be “clean” to the naked eye. This suggested that titanium oxide compounds were present at the interface, where the oxygen required could only result from diffusion bonding across the interface. Diffusion bonding may also explain the significantly higher amounts of zirconium on the coating surface that had been pulled off the smoother lapped ceramic coupons. The measured shear strength of porous‐coated ceramic coupons was significantly higher than that of CoCr and Ti‐6Al‐4V coupons. The superior adherence of the titanium coating to Mg‐PSZ suggests this process has great clinical potential in arthroplasty, especially for patients with metal sensitivity. © 2019 Wiley Periodicals, Inc. J Biomed Mater Res Part A: 107A: 1925–1932, 2019.

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Allergic or Hypersensitivity Reactions to Orthopaedic Implants

Cited by 34 publications

References 42 publications

Metal hypersensitivity in patients with orthopaedic implant complications—A retrospective clinical study

Metal hypersensitivity in patients with orthopaedic implant complications—A retrospective clinical study

Metal duyarlılığı ve metalloz

Enhanced adhesion of plasma‐sprayed commercially pure titanium porous coatings to polished Mg‐PSZ ceramic substrates

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