Incidence of metal sensitivity in patients with total joint replacements.

Abstract

SummarySensitivity to chromium, cobalt, nickel, molybdenum, vanadium, and titanium was studied by patch tests in 50 patients who had received total joint replacements.Nineteen (38%) were sensitive to one or more ofthe metals. In 23 patients non-traumatic failure of the prosthesis had occurred, and 15 of these patients were sensitive to metal. Out of 27 patients with no evidence of prosthesis loosening, four were sensitive to nickel and cobalt or nickel only. Dermatological reactions occurred in 13 patients after surgery; in only eight, however, was there evidence of metal sensitivity. These findings indicate that metal-on-metal total joint replacements may sensitise the patient to metals contained in the prosthesis. Although there is a high incidence of prosthesis failure among metal-sensitive patients it remains uncertain whether the loosening causes the sensitisation or vice versa. IntroductionThere are several well established causes of the loosening of joint prostheses, such as infection, faulty implantation, trauma, and, in early types ofprosthesis, design faults. Recently, however, the development of a state of immunological sensitivity to the metallic components of the joint replacement has been suggested as a further cause of loosening. It is well established that in vivo during the wear of metal-on-metal bearings of prostheses grey-staining particulate material is found in tissues.' 2 These particles have been shown by x-ray fluorescence spectroscopy to be metallic.3 In patients with metal-on-metal hip prostheses both cobalt and chromium can be detected, often in considerable quantities, in the blood, urine, and hair. 4 Recently there have been several reports of patients suffering from urticarial or ezcematous dermatitis, which has been attributed to the presence of an implanted metallic prosthesis or other appliance.5-8 Patch tests showed these patients to be positive

Metal ions in body fluids after arthroplasty

“…The importance of metal release from the implant is due to the risk of toxicity and of sensitivity to metals as a possible cause of Ioosening (Evans et al 1974, Elves et al 1975, Langlais et al 1980, Uchida et al 1980) and of carcinogenicity (Oppenheimer et al 1956, Heath et al 1971, Kazantzis 1981, Norseth 1981. Few long-term studies have been performed on the levels of metal ions in organic fluids of patients with orthopedic implants (Brown et al 1977, Pazzaglia et al 1983.…”

Allergy in Total Knee Replacement. Does it Exist?

“…In nine of 16 retrospective studies, patch testing was used [17,19,33,35,45,51,52,54,61]. In one study, diagnostic procedures also included LTT, ELISA, and confocal microscopy [33].…”

“…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].…”

“…The first reports of loosening after joint replacement caused by hypersensitivity or allergic reactions to metallic implants were published in the mid 70s and 80s [14,19,20,67] and concerned hip arthroplasties with metal-on-metal bearings. More recently, there has been a trend towards studies examining allergies in metal on plastic total knee arthroplasties [14,43].…”

Vanadium und seine anorganischen Verbindungen [MAK Value Documentation in German language, 2006]

“…(Oleffe und Wilmet 1980). In weiteren Berichten wurde -ohne nähere Angaben -über positive Reaktionen auf 0,5% Natriummetavanadat bei 5 von 125 Beschäftigten mit Zement-Ekzem (Geiser 1968) sowie auf 0,1% Ammoniummetavanadat bei einem von 50 Patienten mit Gelenkprothesen berichtet (Elves et al 1975). Keiner von 17 Beschäftigten, die bei der Reinigung der Brennkammern eines Ölkraft-werkes gegen Vanadium-haltigen Staub exponiert worden waren, zeigte im Epikutantest nach 48 Stunden eine positive Reaktion auf 2% Natriumvanadat in Wasser (Lees 1980).…”