Pragmatic approach to the clinical work-up of patients with putative allergic disease to metallic orthopaedic implants before and after surgery

Thyssen, Jacob P.; Menné, Torkil; Schalock, Peter C.; Taylor, James S.; Maibach, Howard I.

doi:10.1111/j.1365-2133.2010.10144.x

Cited by 68 publications

(113 citation statements)

References 47 publications

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“…Some authors believe that some causes of intolerance to metal alloys may be attributable to allergic reactions to the implanted metals [8,9], whereas others do not share this view [10,11]. Furthermore, there is no consensus among the authors on the need for allergy screening to metals prior to the surgery [12,13]. The aims of the study were: to evaluate the allergenic properties of the metal knee and hip implants 24 months after surgery and to assess the relation between allergy to metals and metal implants failure.…”

Section: Discussionmentioning

confidence: 88%

“…In all these cases there was a confirmed presence of allergenic metals in the used implants. Furthermore, 3 women Some researchers agree that individuals without a reported history of metal dermatitis need not be screened prior to implantation [12,22]. What is more, pre-implant screening is not performed routinely in Sweden or Denmark for any patients, and it is not systematically done in other locations either [13].…”

Section: Discussionmentioning

confidence: 99%

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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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Section: Discussionmentioning

confidence: 88%

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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“…This obviously makes it difficult to identify the few allergic subjects at risk before developing implant failure. Although it is a matter of controversy, it seems sensible to refrain from routine patch testing/allergy testing prior to surgery unless the patient has already had implant surgery with complications suspected to be allergic or a history of clinical metal intolerance of sufficient magnitude to be of concern to the patient or a health provider (Thyssen et al 2011a). If a patient is strongly allergic to e.g.…”

Section: Clinical Work-upmentioning

confidence: 99%

“…To demonstrate causal relationship between delayed type of hypersensitivity and aseptic loosening strict criteria (Tab. 2) should be followed (Thyssen et al 2011a). …”

Section: Clinical Work-upmentioning

confidence: 99%

“…loosening of THA. The literature was recently reviewed and it was concluded that metal allergy might in a minority increase the risk of complications caused by a delayed type hypersensitivity reaction (Thyssen et al 2011a). Also, we do not know how to identify the subgroups of metal contact allergic patients with a potentially increased risk of complications following insertion of a metal implant.…”

Section: Epidemiologymentioning

confidence: 99%

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Aseptic Loosening of Total Hip Arthroplasty as a Result of Local Failure of Tissue Homeostasis

Gallo¹,

Konttinen²,

Goodman³

et al. 2012

Recent Advances in Arthroplasty

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The Effect of Patch Testing on Surgical Practices and Outcomes in Orthopedic Patients With Metal Implants

et al. 2012

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To determine the effect of patch testing on surgical decision making and outcomes in patients evaluated for suspected metal hypersensitivity related to implants in bones or joints. Design: Medical chart review. Setting: Tertiary care academic medical center. Participants: All patients who had patch testing for allergic contact dermatitis related to orthopedic implants. Intervention: Patch testing. Main Outcome Measures: The surgeon's preoperative choice of metal implant alloy compared with patch testing results and the presence of hypersensitivity complications related to the metal implant on postsurgical follow-up. Results: Patients with potential metal hypersensitivity from implanted devices (N=72) were divided into 2 groups depending on timing of their patch testing: preimplantation (n=31) and postimplantation (n=41). History of hypersensitivity to metals was a predictor of positive patch test results to metals in both groups. Positive patch test results indicating metal hypersensitivity influenced the decisionmaking process of the referring surgeon in all preimplantation cases (n=21). Patients with metal hypersensitivity who received an allergen-free implant had surgical outcomes free of hypersensitivity complications (n=21). In patients who had positive patch test results to a metal in their implant after implantation, removal of the device led to resolution of associated symptoms (6 of 10 patients). Conclusions: The findings of this study support a role for patch testing in patients with a clinical history of metal hypersensitivity before prosthetic device implantation. The decision on whether to remove an implanted device after positive patch test results should be made on a case-bycase basis, as decided by the surgeon and patient.

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Pragmatic approach to the clinical work-up of patients with putative allergic disease to metallic orthopaedic implants before and after surgery

Cited by 68 publications

References 47 publications

Allergy to orthopedic metal implants — A prospective study

Allergy to orthopedic metal implants — A prospective study

Aseptic Loosening of Total Hip Arthroplasty as a Result of Local Failure of Tissue Homeostasis

The Effect of Patch Testing on Surgical Practices and Outcomes in Orthopedic Patients With Metal Implants

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