Implantatallergieregister – ein erster Erfahrungsbericht

Eben, Ricarda; Walk, R.; Summer, Burkhard; Maier, S.; Thomsen, M.; Thomas, Peter A.

doi:10.1007/s00132-009-1414-x

Cited by 37 publications

(8 citation statements)

References 19 publications

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“…Clinical symptoms of metal hypersensitivity include local or systemic allergic dermatitis, such as eczema, urticaria, bullous eruption, erythema multiforme, and vasculitis. [ 17 , 18 ] Surgical site pain, aseptic inflammation, and prosthetic loosening are also common manifestations. [ 5 ] Different metal ions may induce diverse allergic symptoms, for example: nickel ions may create implant loosening, and release of chrome can cause eczema and other skin problems.…”

Section: Literature Reviewmentioning

confidence: 99%

Metal allergy in total-joint arthroplasty

Bao

Fan

et al. 2018

Medicine

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Rationale:Due to the low incidence and lack of effective diagnostic measures for the diagnosis of metal allergy in patients undergoing total joint arthroplasty (TJA), diagnosis relies mainly on the exclusion of other causes, in particular infection. It remains a relatively unpredictable and poorly understood cause of implant failure. At present, skin patch testing, leukocyte migration inhibition test (LMIT) and lymphocyte transformation tests (LTT) are being commonly used to assess metal hypersensitivity.This report presents both a case and literature review.Patient concerns:A 61-year-old female patient experienced continuous swelling and pain in the right knee joint for 9 months after a right-side total knee arthroplasty (TKA).Diagnoses:We believe this is the case report of metal allergy in TKA. The following were the reasons for this. First, no definite symptoms of infection during revision arthroplasty were observed, but with obvious hyperplasia of synovium. Furthermore, a frozen biopsy revealed an extremely low neutrophil count, which was considered to be caused by chronic inflammation. Second, the results of repeated post-operation reexaminations indicate a clear increase in the number of eosinophils, while no bacteria were found in the tissue bacterial smear performed during the operation. Third, improvements were clearly observed in the patient following synovectomy, revision of the polyethylene insert and anti-anaphylactic treatment.Interventions:The patient underwent synovectomy, revision of the polyethylene insert and anti-anaphylactic treatment.Outcomes:The patient's right knee remained mildly swollen; however, the pain has been relieved significantly. The range of motion could achieve 0 degrees of extension and 90 degrees of flexion.Lessons:No consensus has been reached about the best diagnostic criteria for this disease, and most physicians would consider it to be a possibility when other diseases including periprosthetic joint infection (PJI) have been excluded. Although this case followed the same course, the outcome following synovectomy and anti-anaphylactic treatment further confirmed our hypothesis.

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Section: Literature Reviewmentioning

confidence: 99%

Metal allergy in total-joint arthroplasty

Bao

Fan

et al. 2018

Medicine

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“…Due to favourable tribological properties, a significant reduction in wear rates of ceramic bearings has been well demonstrated in vitro and in vivo [ 4 – 6 ]. Furthermore, the release of wear particles may also elicit allergenic reactions, which are observed with metal implants [ 7 ]. Indeed, the prevalence of metal hypersensitivity is approximately 10–15 %, with nickel sensitivity having the highest prevalence in the presence of a common cross-reactivity between nickel and cobalt [ 8 ].…”

Section: Introductionmentioning

confidence: 99%

First clinical study of a novel complete metal-free ceramic total knee replacement system

et al. 2016

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BackgroundThe aim of the study was to evaluate the safety and efficacy of a novel metal-free ceramic total knee replacement system.MethodsThirty-eight primary total knee arthroplasties (TKAs) were performed on 34 patients using the metal-free BPK-S ceramic total knee replacement system with both the femoral and tibial components of an alumina/zirconia ceramic composite. The clinical outcome was evaluated pre- and postoperatively at 3 (n = 32 TKA) and 12 months (n = 32 TKA) using the Knee Society Score (KSS), the Oxford Knee Score and the EQ-5D. Safety analysis was performed by radiological examination and assessment of adverse events.ResultsPostoperatively, the KSS, Oxford Knee Score and EQ-5D improved significantly at 3 and 12 months (p < 0.001). Non-progressive partial radiolucent lines were observed in six cases, but there was no osteolysis and no implant loosening. Induction or exacerbation of allergies did not occur during the follow-up.ConclusionsThe metal-free BPK-S ceramic total knee replacement system proved to be a safe and clinically efficient alternative to metal implants in this short-term follow-up study.

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“…In connection with metal allergy impaired wound and fracture healing have been described [ 21 ]. Especially in knee arthroplasty we have observed recurrent pain, effusion, loosening and reduced range of motion without infection but with associated metal allergy [ 17 ]. This also applies to patients with hip arthroplasty.…”

Section: Methodsmentioning

confidence: 99%

“…As part of our for more than 10 years existing special ambulatory for patients with suspected implant allergy we see on the one hand patients with unusual clinical pictures. The most common constellation however are knee arthroplasty patients with complaints leading to revision without “conventional orthopedic“ causes such as infection, malposition or malalignement [ 9 , 17 ]. In the following we will inform you about implant materials, clinical pictures and allergy diagnostics in suspected implant allergy.…”

Section: Introductionmentioning

confidence: 99%

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

Thomas

2014

Allergo J Int

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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.

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Implantatallergieregister – ein erster Erfahrungsbericht

Abstract: After excluding causes such as infection or mechanical failure, allergy diagnosis using a patch test with implant metals and bone cement components is recommended in cases of suspected implant allergy.

Cited by 37 publications

References 19 publications

Metal allergy in total-joint arthroplasty

Metal allergy in total-joint arthroplasty

First clinical study of a novel complete metal-free ceramic total knee replacement system

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

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