Metal sensitivity in patients with orthopaedic implants: a prospective study

Frigerio, E.; Pigatto, Paolo D.; Guzzi, Gianpaolo; Gf, Altomare

doi:10.1111/j.1600-0536.2011.01886.x

Cited by 124 publications

(112 citation statements)

References 27 publications

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“…One study used LTT [47], one study used a combination of patch test and LTT [22], two studies used neither of these tests [8,10].…”

Section: Resultsmentioning

confidence: 99%

“…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%

“…A number of papers have reported algorithms to screen for hypersensitivity against metals or bone cement in patients undergoing TKA [4,22,33,63]. Most algorithms highlight the importance of the patient's history of metal hypersensitivity/allergic reaction.…”

Section: Algorithmsmentioning

confidence: 99%

See 2 more Smart Citations

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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“…One study used LTT [47], one study used a combination of patch test and LTT [22], two studies used neither of these tests [8,10].…”

Section: Resultsmentioning

confidence: 99%

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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“…implant one year post-implantation [17]. Furthermore, Waterman et al [18] noted positive tests results in 8 out of 85 (9.4%) patients undergoing hip replacement.…”

Section: Discussionmentioning

confidence: 99%

Allergy to orthopedic metal implants — A prospective study

Krêcisz

Kieć-Swierczyńska

Chomiczewska-Skóra

2012

International Journal of Occupational Medicine and Environmental Health

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Objectives: Evaluation of the allergenic properties of the metal knee or hip joint implants 24 months post surgery and assessment of the relation between allergy to metals and metal implants failure. Materials and Methods: The study was conducted in two stages. Stage I (pre-implantation) -60 patients scheduled for arthroplasty surgery. Personal interview, dermatological examination and patch testing with 0.5% potassium dichromate, 1.0% cobalt chloride, 5.0% nickel sulfate, 2.0% copper sulfate, 2.0% palladium chloride, 100% aluminum, 1% vanadium chloride, 5% vanadium, 10% titanium oxide, 5% molybdenum and 1% ammonium molybdate tetrahydrate were performed. Stage II (post-surgery) -48 subjects participated in the same procedures as those conducted in Stage I. Results: Stage I -symptoms of "metal dermatitis" were found in 21.7% of the subjects: 27.9% of the females, 5.9% of the males. Positive patch test results were found in 21.7% of the participants, namely to: nickel (20.0%); palladium (13.3%); cobalt (10.0%); and chromium (5.9%). The allergy to metals was confirmed by patch testing in 84.6% of the subjects with a history of metal dermatitis. Stage II -10.4% of the participants complained about implant intolerance, 4.2% of the examined persons reported skin lesions. Contact allergy to metals was found in 25.0% of the patients: nickel 20.8%, palladium 10.4%, cobalt 16.7%, chromium 8.3%, vanadium 2.1% Positive post-surgery patch tests results were observed in 10.4% of the patients. The statistical analysis of the pre-and post-surgery patch tests results showed that chromium and cobalt can be allergenic in implants. Conclusions: Metal orthopedic implants may be the primary cause of allergies. that may lead to implant failure. Patch tests screening should be obligatory prior to providing implants to patients reporting symptoms of metal dermatitis. People with confirmed allergies to metals should be provided with implants free from allergenic metals.

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“…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%

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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Metal sensitivity in patients with orthopaedic implants: a prospective study

Cited by 124 publications

References 27 publications

Allergy in Total Knee Replacement. Does it Exist?

Allergy in Total Knee Replacement. Does it Exist?

Allergy to orthopedic metal implants — A prospective study

Hypersensitivity Reactions to Implanted Metal Devices: Facts and Fictions

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