A prospective study concerning the relationship between metal allergy and post-operative pain following total hip and knee arthroplasty

Zeng, Yirong; Feng, Wenjun; Li, Jie; Lu, Lu; Ma, C.B.; Zeng, Jianchun; Li, Feilong; Qi, Xinyu; Fan, Yueguang

doi:10.1007/s00264-014-2367-1

Cited by 29 publications

(24 citation statements)

References 34 publications

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“…Also cell-mediated hypersensitivity reactions are associated with metal wear debris [25]. A combination of these factors may be the underlying cause for the higher incidence of reported pain in patients with elevated serum ion levels [22,26].…”

Section: Discussionmentioning

confidence: 98%

Large fixed-size metal-on-metal total hip arthroplasty: higher serum metal ion levels in patients with pain

Smeekes

Ongkiehong

Wal

et al. 2014

International Orthopaedics (SICOT)

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Section: Discussionmentioning

confidence: 98%

Large fixed-size metal-on-metal total hip arthroplasty: higher serum metal ion levels in patients with pain

Smeekes

Ongkiehong

Wal

et al. 2014

International Orthopaedics (SICOT)

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“…However, $20% of patients with TKAs are unsatisfied. 3,4 Such patients will complain of chronic pain, swelling, intra-articular fluid collection, limitation of movement, or aseptic loosening of the prosthesis. Some develop de novo dermatitis, limited to the region of the implant or generalized.…”

mentioning

confidence: 99%

Patch Test Results and Outcome in Patients with Complications from Total Knee Arthroplasty: A Consecutive Case Series

2019

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The role of hypersensitivity in implant-related complications remains controversial. The objectives of our study were to (1) establish the prevalence of hypersensitivity to components of knee prostheses in patients referred to our contact dermatitis clinic, (2) determine if patients with post-surgery dermatitis have become sensitized, and (3) describe the outcome of patients with and without hypersensitivity. We reviewed the charts of patients referred from 2007 to 2018 and extracted demographic information, date, type, and site of implant, clinical presentation, and results of patch testing (PT) or lymphocyte transformation tests (LTT). We called most patients to gather data such as clinical outcome, nature, and timing of additional surgery. Statistical analysis included computation of conventional descriptive statistics. Because of the type of study design, only some categorical variables were tested for possible associations by analytical tools (cross-tabulation). Thirty-nine patients, 23 men (59.0%), and 16 women (41.0%), were included. Their mean age in years was 63.3 (95% confidence interval [CI]: 60.9–65.7) ranging from 39.0 to 79.0, (standard deviation) = 9.69, without statistically significant differences between males and females. Five patients had positive PT possibly relevant to their implant. Four patients had revision surgery and two improved. Of nine patients with dermatitis, one with relevant PT did not improve after revision, and the dermatitis was unrelated to TKA in eight. Of the 26 patients without dermatitis or relevant PT results, 9 had revisions because of incapacitating symptoms, and 5 improved. Hypersensitivity to implant components is a potential factor in the etiology of TKA complications. Patients with confirmed hypersensitivity may benefit from revision. Our study, however, did not detect statistically significant differences in outcome of revision surgery between patients with positive versus negative PT or LTT. In spite of this, we consider that patients with a history suggestive of metal, acrylate or aminoglycoside allergy should be tested preoperatively to avoid hypersensitivity-related postoperative complications. In the absence of hypersensitivity, some patients with incapacitating symptoms may also improve following revision.

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“…Out of eight prospective studies, five included patch testing [2,25,40,69]. 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%

Allergy in Total Knee Replacement. Does It Exist?

2016

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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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A prospective study concerning the relationship between metal allergy and post-operative pain following total hip and knee arthroplasty

Cited by 29 publications

References 34 publications

Large fixed-size metal-on-metal total hip arthroplasty: higher serum metal ion levels in patients with pain

Large fixed-size metal-on-metal total hip arthroplasty: higher serum metal ion levels in patients with pain

Patch Test Results and Outcome in Patients with Complications from Total Knee Arthroplasty: A Consecutive Case Series

Allergy in Total Knee Replacement. Does It Exist?

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