Clinical and diagnostic challenges of metal implant allergy using the example of orthopaedic surgical implants

Abstract

SummaryThe focus of this review are allergic reactions to orthopaedic-surgical metal implants. The spectrum of metal implant associated potential allergic reactions encompasses eczema, impaired wound and fracture healing, infection-mimicking reactions, effusions, pain and loosening. Nickel, cobalt and chromium seem to be the predominant eliciting allergens. Despite the growing number of respective publications the topic „metal implant allergy“ remains a diagnostic challenge. Initially, differential diagnoses should always be excluded in cooperation with surgery collegues. It is recommended to perform a combined evaluation of medical history, clinical findings, patch testing and histology. The lymphocyte transformation test (LTT) can indicate metal sensitization, but it needs careful interpretation. Allergists can provide a substantial contribution to this interdisciplinary topic.

Development of antimicrobial composite coatings for drug release in dental, orthopaedic and neural prostheses applications

“…Although metallic implants have the appropriate mechanical properties and relatively good corrosion resistance, they can cause metal-allergic reactions in certain patients and possible infection after surgery. Therefore, various types of surface modifications on the metallic implants have been designed and developed in order to eliminate these uncertainties [13,14].…”

Systemic contact dermatitis to a surgical implant presenting as red decorative tattoo reaction

“…For symptomatic individuals with refractory dermatitis and for whom device removal is considered reasonable, the device may be removed. In individuals for whom implant removal is not possible, a tapered dose of oral prednisone over 21 days may be helpful 1, 2, 3. For tattoo-related dermatitis, varying degrees of success with oral allopurinol, topical and intralesional corticosteroids, antibiotics, surgical excision, and laser have been reported 4, 7, 8, 9…”

“…Hallab et al 10 found a weighted mean prevalence of hypersensitivity to nickel, cobalt, or chromium in 25% of patients with well-functioning hip arthroplasties compared with a prevalence of 60% of patients with a failed or poorly functioning hip implant. Common symptoms include dermatitis at the implant site, implant loosening, impaired healing, and joint pain 1, 2, 3, 11…”

Neuropathy Caused by Metal Hypersensitivity after Placement of Stainless Steel Plate

“…There was not any previous report suggesting metal hypersensitivity manifested in the form of neurop-athy or tendinopathy from metal plate implantation [6]. Impaired wound healing, eczema, sterile osteomyelitis, and tissue swelling were the reported implant-associated allergic reactions from stainless steel plates [7].…”