Biomaterial Hypersensitivity: Is It Real? Supportive Evidence and Approach Considerations for Metal Allergic Patients following Total Knee Arthroplasty

Mitchelson, Andrew J; Wilson, Craig J.; Mihalko, William M.; Grupp, Thomas M.; Manning, Blaine; Dennis, Douglas A.; Goodman, Stuart B.; Tzeng, Tony H.; Vasdev, Sonia; Saleh, Khaled J.

doi:10.1155/2015/137287

Cited by 73 publications

(80 citation statements)

References 63 publications

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“…Seventy articles were excluded after reviewing the title and abstract (some exclusion criteria: other joints than knee, allergic reaction to medication during surgery, infection, antibiotics, metallosis, and allergic reaction to suture material after surgery). Forty-six articles were included in the review: 17 case reports (Table 1), 4 reviews [5,15,42,43], 16 retrospective articles [11,17,19,26,32,33,35,41,45,46,48,51,52,54,61,63], 8 prospective articles [2,8,10,22,25,40,47,69], and one "expert opinion" [39].…”

Section: Methodsmentioning

confidence: 99%

See 1 more Smart Citation

Allergy in Total Knee Replacement. Does it Exist?

Faschingbauer

Renner

Boettner

2017

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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Background: There is little data on whether preexisting allergies to implant materials and bone cement have an impact on the outcome of TKA. Questions/Purposes: This review article analyzes the current literature to evaluate the prevalence and importance of metal and cement allergies for patients undergoing total knee arthroplasty. Methods: A review of the literature was performed using the following search criteria: "knee," "arthroplasty," and "allergy" as well as "knee," "arthroplasty," and "hypersensitivity." Results: One hundred sixteen articles were identified on PubMed, Seventy articles could be excluded by reviewing the title and abstract leaving 46 articles to be included for this review. The majority of the studies cited patch testing as the gold standard for screening and diagnosis of hypersensitivity following TKA. There is consensus that patients with self-reported allergies against metals or bone cement and positive patch test should be treated with hypoallergenic materials or cementless TKA. Treatment options include the following: coated titanium or cobalt-chromium implants, ceramic, or zirconium oxide implants. Conclusion: Allergies against implant materials and bone cement are rare. Patch testing is recommended for patients with self-reported allergies. The use of special implants is recommended for patients with a confirmed allergy.

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Section: Methodsmentioning

confidence: 99%

“…More recently, there has been a trend towards studies examining allergies in metal on plastic total knee arthroplasties [14,43].…”

Section: Introductionmentioning

confidence: 99%

Allergy in Total Knee Replacement. Does it Exist?

Faschingbauer

Renner

Boettner

2017

HSS Journal®: The Musculoskeletal Journal of Hospital for Speci

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“…Therefore, patch testing appears to be the best available approach for potential metal hypersensitivity reactions, both before and after implantation, while the role of LTT in clinical practice remains unclear [204,[211][212][213]. Schalock et al [184,211] recommended a protocol for patch testing using a baseline series and an adjunctive metal series based on implant type [214].…”

Section: Which Test?mentioning

confidence: 99%

Hypersensitivity Reactions to Implanted Metal Devices: Facts and Fictions

2016

J Investig Allergol Clin Immunol

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The use of metals in the medical field has become increasingly prevalent over the past few decades. Patients find themselves being exposed to metals in a variety of ways, ranging from external exposure to instruments such as the stainless steel in surgical blades to internal exposure via medical devices being implanted in their bodies. There has been growing interest in the possibility of developing hypersensitivity reactions to constituent metals in medical implant devices, both in cutaneous and systemic forms. Hypersensitivity reactions to metals are uncommon, but they are reported and require appropriate evaluation and management, particularly if they are symptomatic. In view of the lack of consensus in the field on the appropriate steps to evaluate and manage patients with suspected metal hypersensitivity reactions, this review aims to analyze current evidence on hypersensitivity reactions to metallic implants in orthopedic surgery, endovascular surgery, obstetrics and gynecology, and dental surgery. Key words: Metal hypersensitivity. Metallic implants. ResumenEl empleo de metales dentro de la medicina ha ido aumentando de forma progresiva en las últimas décadas. Los pacientes se exponen a metales de diferentes formas desde fuentes externas, como instrumental quirúrgico como el presente en las hojas de acero de los bisturíes, hasta implantes metálicos. Como consecuencia de ello se está produciendo un interés creciente por la posibilidad de desarrollar reacciones de hipersensibilidad a metales presentes en los materiales y objetos implantados, tanto en forma de reacciones cutáneas como sistémicas. Las reacciones de hipersensibilidad a metales no son frecuentes, pero pueden desarrollarse, y por ello, requieren de un diagnóstico y tratamiento adecuado, especialmente en aquellos pacientes que desarrollen síntomas. No existe un consenso en el proceso diagnóstico ni en el tratamiento de estas reacciones en los pacientes con sospecha de alergia a metales. Esta revisión tiene por objeto actualizar la evidencia existente sobre las reacciones de hipersensibilidad a implantes metálicos en cirugía ortopédica, cirugía endovascular, cirugía obstétrica y ginecológica (OB-GYN) así como la dental. Palabras clave: Hipersensibilidad a metales. Implantes metálicos.

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“…However, the process of implantation of prosthetic devices is costly, highly traumatic and can lead to multiple complications, such as infection, inflammation and pain. Furthermore, such prosthetic implants have a limited lifespan (Glyn-Jones et al, 2015) and pose the risk of inducing biomaterial hypersensitivity (Mitchelson et al, 2015).…”

Section: R Sommaggio Et Al Barriers To Chondrocyte Xenotransplantationmentioning

confidence: 99%

“…This lack of reactivity cannot be attributed to defective reagents during these determinations, as positive signals were obtained with porcine aortic endothelial cells (PAECs). In fact, the differences observed between PCs and PAECs are highly relevant as all these adhesion and co-stimulatory molecules promote leukocyte adhesion and together with SLA mediate direct activation of different subsets of human T cells (Murray et al, 1994;Rollins et al, 1994). Furthermore, these can also contribute to the recognition of pig cells by human natural killer (NK) cells (Costa et al, 2002;Sommaggio et al, 2012).…”

Section: Cellular Immune Responsementioning

confidence: 99%

Xenotransplantation of pig chondrocytes: therapeutic potential and barriers for cartilage repair

Sommaggio

Uribe‐Herranz²,

Marquina³

et al. 2016

eCM

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Transplantation may be the best option for the repair of many cartilage lesions including early osteoarthritis. Currently, autologous and allogeneic chondrocytes are grafted into cartilage defects to treat selected patients with moderate clinical success. However, their limited use justifies exploring novel therapies for cartilage repair. Xenotransplantation could become a solution by offering high cell availability, quality and genetic engineering capabilities. The rejection process of xenogeneic cartilage is thus being elucidated in order to develop counteractive strategies. Initial studies determined that pig cartilage xenografts are rejected by a slow process comprising humoral and cellular responses in which the galactose α1,3-galactose antigen participates. Since then, our group has identified key mechanisms of the human response to pig chondrocytes (PCs). In particular, human antibody and complement contribute to PC rejection by inducing a pro-inflammatory milieu. Furthermore, PCs express and up-regulate molecules which are functionally relevant for a variety of cellular immune responses (SLA-I, the potent co-stimulatory molecule CD86, and adhesion molecules VCAM-1 and ICAM-1). These participate by triggering a T cell response, as well as supporting a prominent role of the innate immune responses led by natural killer (NK) cells and monocytes/macrophages. Human NK cells lyse PCs by using selected NK activating receptors, whereas human monocytes are activated by PCs to secrete cytokines and chemokines. All this knowledge sets the bases for the development of genetic engineering approaches designed to avert rejection of xenogeneic chondrocytes and leads the way to developing new clinical applications for cartilage repair.

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Biomaterial Hypersensitivity: Is It Real? Supportive Evidence and Approach Considerations for Metal Allergic Patients following Total Knee Arthroplasty

Cited by 73 publications

References 63 publications

Allergy in Total Knee Replacement. Does it Exist?

Allergy in Total Knee Replacement. Does it Exist?

Hypersensitivity Reactions to Implanted Metal Devices: Facts and Fictions

Xenotransplantation of pig chondrocytes: therapeutic potential and barriers for cartilage repair

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