Allergy to orthopedic metal implants — A prospective study

Abstract

Objectives: Evaluation of the allergenic properties of the metal knee or hip joint implants 24 months post surgery and assessment of the relation between allergy to metals and metal implants failure. Materials and Methods: The study was conducted in two stages. Stage I (pre-implantation) -60 patients scheduled for arthroplasty surgery. Personal interview, dermatological examination and patch testing with 0.5% potassium dichromate, 1.0% cobalt chloride, 5.0% nickel sulfate, 2.0% copper sulfate, 2.0% palladium chloride, 100% aluminum, 1% vanadium chloride, 5% vanadium, 10% titanium oxide, 5% molybdenum and 1% ammonium molybdate tetrahydrate were performed. Stage II (post-surgery) -48 subjects participated in the same procedures as those conducted in Stage I. Results: Stage I -symptoms of "metal dermatitis" were found in 21.7% of the subjects: 27.9% of the females, 5.9% of the males. Positive patch test results were found in 21.7% of the participants, namely to: nickel (20.0%); palladium (13.3%); cobalt (10.0%); and chromium (5.9%). The allergy to metals was confirmed by patch testing in 84.6% of the subjects with a history of metal dermatitis. Stage II -10.4% of the participants complained about implant intolerance, 4.2% of the examined persons reported skin lesions. Contact allergy to metals was found in 25.0% of the patients: nickel 20.8%, palladium 10.4%, cobalt 16.7%, chromium 8.3%, vanadium 2.1% Positive post-surgery patch tests results were observed in 10.4% of the patients. The statistical analysis of the pre-and post-surgery patch tests results showed that chromium and cobalt can be allergenic in implants. Conclusions: Metal orthopedic implants may be the primary cause of allergies. that may lead to implant failure. Patch tests screening should be obligatory prior to providing implants to patients reporting symptoms of metal dermatitis. People with confirmed allergies to metals should be provided with implants free from allergenic metals.

Prospective analysis of the incidence of metal allergy in patients listed for total replacement of the temporomandibular joint

“…5 The efficacy of patch testing for allergies to metal in orthopaedic patients has been debated. 6,7 In a review, Thyssen et al 8 concluded that clinicians refrain from wholesale patch testing. One of the key points in their argument was that of cost-benefit.…”

Positive Reactions to Nickel on a Patch Test Do Not Predict Clinical Outcome of Nickel Alloy-Based Atrial Septal Defect Occluder Implantation

“…In the field of orthopedics, metal orthopedic implants are considered to be the primary cause of allergies that may lead to implant failure [4,5,17]. Patch test screening has increasingly been suggested to be obligatory prior to orthopedic metal implant insertion in patients reporting symptoms of metal dermatitis.…”

“…In the field of orthopedics, metal orthopedic implants have been implicated as the primary cause of allergies that may lead to implant failure. Kręcisz et al [5] insisted that patch test screening should be obligatory prior to implanting these devices into patients reporting symptoms of metal dermatitis and that patients with confirmed allergies to metals should be provided with implants without allergenic metals. Although anecdotal reports have chronicled side effects, such as pericarditis, chest discomfort, migraine headache and ASD occluder embolization leading to device removal after intracardiac device implantation [2,6,7,8], some authors reported successful transcatheter closure even in patients with symptomatic nickel allergy, suggesting that nickel allergy per se is not a contraindication to ASD closure with a nitinol device; however, these contradictory results and concerns about the safety associated with long-term effects of implants underscore the value of post-implantation surveillance studies.…”

Hypersensitivity Reactions to Implanted Metal Devices: Facts and Fictions

“…They found that the probability of developing a metal allergy was higher after surgery (OR, 1.52; 95%CI, 1.06-2.31) and that the risk was even higher when failed implants were compared with stable total joint replacements (OR, 2.76; 95%CI, 1.14-6.70) [25]. A few recent prospective studies have also suggested an increase in cases of metal allergy following THA, even in patients with well-functioning prostheses [26][27][28].…”

“…Stainless steel, which contains a large percentage of nickel, is often used for screws while cobalt-chromium alloy, which has approximately 1% nickel content, is often used in total joint arthroplasty [9,32]. Metal hypersensitivity has long been studied as a potential cause of complications after total joint arthroplasty, ever since the first case of metal-related dermatitis was first reported in 1966 [33][34][35][36][37]. Cutaneous manifestations of suspected metal hypersensitivity reactions can include localized and generalized eruptions in the form of erythema, urticaria, and vasculitis, and such manifestations can be observed with static implants, dynamic joint prostheses, and, occasionally, in the implants used in TKA [16,[38][39][40][41][42][43].…”