Metal hypersensitivity testing in patients undergoing joint replacement

Granchi, Donatella; Cenni, E.; Giunti, Armando; Baldini, Nicola

doi:10.1302/0301-620x.94b8.28135

Cited by 152 publications

(147 citation statements)

References 49 publications

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“…This approach is similar to that suggested by Granchi et al [25], who performed a comprehensive systematic review on metal allergy and total joint replacement in 2012. Thyssen et al [197] took it a step further and recommended that clinicians refrain from carrying out routine patch testing prior to surgery, unless the patient reports having a history of clinical metal intolerance of a magnitude sufficient to cause concern to the patient or to the doctor.…”

Section: Is There a Need For Allergy Testing Before Implantation?mentioning

confidence: 78%

“…In 2012, the same group performed a systematic review and meta-analysis of peer-reviewed literature that focused on metal sensitivity testing in patients undergoing total joint replacement. 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].…”

Section: The Rising Potential Impact Of Metal Hypersensitivitymentioning

confidence: 99%

“…Webley et al [99] studied 50 patients with hinged arthroplasty of the knee in 1978 and found that while 32% (n=16) had positive patch test results to the metal constituents, there was no correlation with loosening of the prosthesis [99]. In 2007, Granchi et al [25] reported that while there is a higher frequency of patch testing in patients with TKA than in the normal population, no predictive value of TKA failure could be attributed to sensitization, as patch testing was similarly frequent in both patients with stable and patients with loose implants.…”

Section: Is There a Need For Allergy Testing Before Implantation?mentioning

confidence: 99%

“…Geisinger et al [217] noted that in addition to physical, mechanical, and biomedical issues, a outcomes [222]. Granchi et al [25] reported that the presence of symptoms of metal allergy before implantation might be a risk factor for TKA failure, and Nam et al [101] found that patient-reported metal allergy was associated with decreased functional outcomes (University of California at Los Angeles Activity, Short Form 12 , Modified Harris Hip Score, and Knee Society Score) after TKA and decreased mental health scores after THA. Earlier studies report similar findings, ie, multiple, patient-reported allergies may be a surrogate for mental health factors that negatively impact postoperative morbidity and functional and psychosocial outcomes [223][224][225].…”

Section: Is There a Need For Allergy Testing Before Implantation?mentioning

confidence: 99%

See 3 more Smart Citations

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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Section: Is There a Need For Allergy Testing Before Implantation?mentioning

confidence: 78%

Section: The Rising Potential Impact Of Metal Hypersensitivitymentioning

confidence: 99%

Section: Is There a Need For Allergy Testing Before Implantation?mentioning

confidence: 99%

Section: Is There a Need For Allergy Testing Before Implantation?mentioning

confidence: 99%

See 2 more Smart Citations

Hypersensitivity Reactions to Implanted Metal Devices: Facts and Fictions

2016

J Investig Allergol Clin Immunol

View full text Add to dashboard Cite

show abstract

“…The probability of developing a metal allergy seems to be higher post-operatively and the risk further increased when failed implants were compared with stable TJRs [8] …”

mentioning

confidence: 99%