Morbidity After Metal Allergy to a Total Ankle Implant

Gaston, Tara; Kwan, Stephanie; Skibicki, Hope E.; Cheesman, Quincy T.; Daniel, Joseph N.

doi:10.1177/1938640020950119

Cited by 6 publications

(2 citation statements)

References 10 publications

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“…Наприклад, залізо є необхідним компонентом гемоглобіну в еритроцитах, кобальт входить до складу вітаміну B 12 , тому без цих металів організм не може виробляти еритроцити. Цинк та мідь беруть участь у процесах метаболізму, а дефіцит будь-якого з них може призвести до розвитку анемії [6]. Водночас ці та інші метали, попадаючи в організм людини у великій кількості, можуть викликати тяжкі хвороби, у тому числі і алергію.…”

Section: вступunclassified

The Problem of Diagnosis of Metal Allergy in a Clinical Case

Besh¹,

Sorokopud²,

Kondratyuk³

et al. 2023

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Abstract. The number of patients with clinical manifestations of allergies demonstrates annual growth worldwide. The most common allergens are household and pollen ones, but there is growing evidence of increase in the number of people with hypersensitivity to metals. The main clinical symptoms are stomatitis, gingivitis, sinusitis, but in some patients we observe systemic manifestations: chronic urticaria, angioneurotic edema, bronchial asthma.The prevalence of allergy to metals is high in the general population, and it is estimated that up to 20 % of Europeans and up to 17 % of the US population suffer from nickel allergies, 4 % are hypersensitive to chromium and about 7-9 % of the population are sensitized to cobalt. Clinical manifestations of allergy to metals may not appear immediately in the first days or even weeks after the installation of metal structures. Due to the peculiarity of the immune response, the symptoms of the disease may manifest atypically and are difficult to diagnose. In patients after hip or knee replacement the allergic reaction may manifest itself not as urticaria or allergic rhinitis, but as aseptic bursitis or prolonged poor postoperative wound healing, muscle necrosis or pain at the site of surgery. Cobalt may induce local apoptosis and lymphocytosis, leading to marked local tissue damage. Our patient had symptoms of allergy to dental implants for two years, but they were disguised as laryngotracheitis, sinusitis, and obstructive bronchitis. After receiving the diagnostic results, it was decided to remove the implant and prescribe desensitizing therapy. After 2 weeks after the removal of the metal structure, and currently, the patient has no complaints and clinical manifestations of laryngotracheitis, sinusitis, and brochitis. So, patch testing is a simple and reliable method of contact allergy diagnosing. Key words: allergy to metals, dental implants, patch testing.

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Section: вступunclassified

The Problem of Diagnosis of Metal Allergy in a Clinical Case

Besh¹,

Sorokopud²,

Kondratyuk³

et al. 2023

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“…26 There is a case report of a TAR patient with a severe metal allergy necessitating implant removal and conversion to fusion. 29 In addition, a study of ankle fusion patients with workers' compensation reported significantly lower American Orthopaedic Foot & Ankle Society scores and higher pain scores postoperatively. 28 However, most of these potential causes are extrapolated from the total hip/ knee replacement population and have not been well described in the TAR literature.…”

Section: Is It Something Unique/rare?mentioning

confidence: 99%

Evaluating and Managing the Painful Total Ankle Replacement

et al. 2021

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The number of total ankle replacements (TARs) performed in the United States has dramatically increased in the past 2 decades due to improvements in implant design and surgical technique. Yet as the prevalence of TAR increases, so does the likelihood of encountering complications and the need for further surgery. Patients with new-onset or persistent pain after TAR should be approached systematically to identify the cause: infection, fracture, loosening/subsidence, cysts/osteolysis, impingement, and nerve injury. The alignment of the foot and ankle must also be reassessed, as malalignment or adjacent joint pathology can contribute to pain and failure of the implant. Novel advanced imaging techniques, including single-photon emission computed tomography and metal-subtraction magnetic resonance imaging, are useful and accurate in identifying pathology. After the foot and ankle have been evaluated, surgeons can also consider contributing factors such as pathology outside the foot/ankle (eg, in the knee or the spine). Treatment of the painful TAR is dependent on etiology and may include debridement, bone grafting, open reduction and internal fixation, realignment of the foot, revision of the implants, arthrodesis, nerve repair/reconstruction/transplantation surgery, or, in rare cases, below-knee amputation. Level of Evidence: Level V, expert opinion or review.

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