The Role of Patch Testing in the Evaluation of Orthopedic Implant-Related Adverse Effects

Abstract

In recent years, there has been a growing interest in the use of skin patch testing to evaluate patients for orthopedic, implant-related adverse effects. This may be done preoperatively to avoid implanting a material to which an individual may be allergic or postoperatively to implicate sensitivity as a cause for implant failure. There is emerging evidence that patch testing might have utility in the workup of implant-related adverse events; however, the level of evidence at the present time is weak and based only on a collection of case reports, series, and retrospective cohort studies (level IV evidence as per United States Department of Health and Human Services guidelines); there are no randomized controlled trials (level I evidence) with which to guide medical decision making. Recent reports have advocated that patch testing be broadly used in the preoperative evaluation of all patients self-reporting a history of metal sensitivity. In addition, several authors have advocated that patch test results should guide preoperative implant selection and postoperative implant removal. It is the opinion of this author that these recommendations are premature, lacking robust clinical evidence, and unfeasible given the broad-reaching logistical impact and societal costs involved. More robust clinical data are needed, and thorough cost-benefit analyses must be performed before such far-reaching and costly systematic practices should be broadly implemented.

Implants and hypersensitivity

“…Az imp lan tá tum beül te tést hó na pok kal vagy évek kel kö ve tő, ké sői tí pu sú túl ér zé keny sé gi reak ció me ch anizmu sa je len leg még nem tel je sen fel tér ké pe zett (19). Az ízü le ti imp lan tá tum ki vál tot ta szen zi bi li zá ció kiala ku lá sa (csont-fém, fém-fém kap cso la tá ban) az abra zív ter he lés után meg je le nő fém par ti cu lu mo kon ala pul, mely nek követ kez mé nye ként a fém io nok és -szem csék ide gen test reak ciót, majd csont re sorp ci ót pro vo kál nak (104).…”

“…A ma kro fá gok a túl nagy par ti cu lu mok ha tá sá ra (csepp sze rű zár vá nyok kiala ku lá sá val) ide gen test óriás sej te ket ké pez nek. Az emel ke dett IL1, IL6 és TNF-α oste oc last in duk ció ja osteoly sist és an gi o ge ne zist ered mé nyez, mely az imp lan tátum la zu lá sá hoz ve zet (19).…”

“…Az ortopédiai mű té tek kö zül a csí pő-és a térdmű tét a leg gya ko ribb (19,47,102,103,111). Iro dal mi ada tok alap ján az Egye sült Ál la mok ban (19) 2009-ben több, mint egy mil lió beavat ko zás tör tént, mely nek költ sé ge elér te a 17,5 mil liárd dol lárt. Becs lé seik sze rint 2030-ig 4,5 mil lió mű tét 50 bil lió dol lár ér ték ben ter ve zett.…”

“…Az imp lan tá tu mok össze te vői ki vál tot ta szen zi bi li zá ció vizs gá la tá ra al kal ma zott in vi vo tesz tek kö zött a gya korlat ban az el ső he lyen, "arany stan dard ként" az epi cu tan pró bák sze re pel nek (19,44,105).…”

Patch Testers’ Opinions Regarding Diagnostic Criteria for Metal Hypersensitivity Reactions to Metallic Implants

“…1 An overview of these reactions was recently published by Basko-Plluska et al 1 Although the prevalence, morbidity, appropriate diagnostic criteria, diagnostic methods (patch testing and/or lymphocyte transformation testing), and treatment options are not well delineated with objective data, 2 we have recently attempted to review the literature to establish reliable practical diagnostic criteria and methods that are clinically useful for physicians. Metal hypersensitivity reactions may occur from essentially any metal-containing device including dental/orthodontic, fixed and static orthopedic, intravascular, and gynecologic.…”