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

Abstract

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.

Metal hypersensitivity in patients with orthopaedic implant complications—A retrospective clinical study

“…Only a few studies have compared patch test results between PO and postoperative patients . The prevalence of positive patch test reactions to any metal was similar to ours, with higher proportions in postoperative patients than in our study.…”

“…The prevalence of positive patch test reactions to any metal was similar to ours, with higher proportions in postoperative patients than in our study. However, the individual share of positive test reactions for each metal was higher in both PO and postoperative patients in the study of Atanaskova Mesinkovska et al, whereas Reed et al did not observe any positive reactions to a prosthesis component in postoperative patients …”

Metal duyarlılığı ve metalloz

“…Bu çalışmanın sonuç kısmında, ameliyat öncesi öyküsünde metal alerjisi olanlara mutlaka yama testi yapılması önerilirken; ameliyat sonrası dönemde ilişkili olabilecek yakınma varlığında test yapılması düşünülmeli, testte pozitiflik saptanırsa uygun implantlarla revizyon yapılması önerilmektedir. [26] Bravo ve ark. 'nın güncel bir çalışmasında, diz eklem protezi uygulaması öncesi deri yama testi ile metallere karşı duyarlılık saptanan hastalarda hipoalerjen değil standart protez kullanılmıştır.…”

Metal Hypersensitivity Reactions to Orthopedic Implants

“…The role of the LTT remains unclear, but seems to be gaining support for use in conjunction with the patch test and potentially coupled with peri-implant histopathology [60, 67, 75, 76]. Protocols for patch testing have been proposed based on implant type and surgical location [60, 77, 78].…”