Allergy in total knee arthroplasty

Middleton, Simon; Toms, Andrew

doi:10.1302/0301-620x.98b4.36767

Cited by 88 publications

(75 citation statements)

References 40 publications

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“…Some manufacturers use them to minimize the allergenic potential of implants made of CoCrMo alloy, predominantly in knee arthroplasties (Corin Group, ; DOT Coatings GmbH, ; Granchi et al, ; Implantcast GmbH, ; Lachiewicz, Watters, & Jacobs, ; Reich et al, ). This is because TiN and similar films can act as a barrier protecting the substrate material from corrosion and metal ion release (Corin Group, ; Granchi et al, ; Implantcast GmbH, ; Lachiewicz et al, ; Middleton & Toms, ; Reich et al, ; Thomsen, Rozak, & Thomas, ). The clinical use of such components is the subject of debate, predominantly because immunological mechanisms of metal hypersensitivity in patients with knee replacements are not well understood (Bravo et al, ; Caicedo, Solver, Coleman, Jacobs, & Hallab, ; Granchi et al, ; Lachiewicz et al, ; Middleton & Toms, ).…”

Section: Introductionmentioning

confidence: 99%

Retrieval analysis of TiN (titanium nitride) coated knee replacements: Coating wear and degradation in vivo

Łapaj

Rozwalka

2019

J Biomed Mater Res

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Introduction Titanium nitride (TiN) coatings are used in joint arthroplasty to minimize wear and reduce the allergenic potential of metal implants, yet little is known about their performance in knee arthroplasty. This retrieval study examined TiN coated knee replacements to verify in vivo wear and degradation of the coating. Materials and methods This study included total and unicompartmental mobile bearing knee replacements retrieved from five patients (eight components) after 13–21 months due to aseptic loosening or infection. Implants were examined using scanning (SEM) and optical microscopy, surface damage was assessed using a semiquantitative scoring system, adhesion was determined using indentation technique testing, surface roughness was measured using contact profilometry. Results Although good coating adhesion and no gross failure were observed on all retrievals, coating wear and roughening were evident on tibial bearing surfaces. Multiple microscopic defects (pinholes, craters, titanium droplets) were observed on all samples in SEM studies. Microscopic wear scars indicated that particulate defects significantly contributed to coating wear, acting as third bodies. Conclusion TiN coatings of knee replacements undergo wear and degradation related to presence of third bodies and microscopic defects on their surface. Since coating integrity may be compromised in vivo, such implants should be used with caution in metal sensitive patients.

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Section: Introductionmentioning

confidence: 99%

Retrieval analysis of TiN (titanium nitride) coated knee replacements: Coating wear and degradation in vivo

Łapaj

Rozwalka

2019

J Biomed Mater Res

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“…In contrast, allergic responses to metallic joint implants represent an uncommon phenomenon, occurring in an estimated 0.1% 10. The exact reason for this is disparity is unknown, but differences in the type of APC and its response to metals in skin versus deep joint tissues has been postulated 11. Furthermore, numerous reports in the literature exist of patients with documented metal allergy doing well with implants containing the offending metals 12 13.…”

Section: Discussionmentioning

confidence: 99%

Vanadium allergy following total knee arthroplasty

Peat¹,

Coomber

Adnan

et al. 2018

BMJ Case Reports

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Allergic reactions to metals following joint arthroplasty represent a rare and poorly understood phenomenon. Much is still unknown regarding the natural history of this complication, and how it can best be prevented and managed. We present a case of a 68-year-old woman who underwent a left total knee arthroplasty for treatment of osteoarthritis. After an initial uneventful postoperative course, she developed a troublesome erythematous rash both around the incision site and over her trunk. Blood testing revealed no evidence of infection and clinically her prosthesis was functioning well. Skin patch testing revealed positive results for vanadium (+) and palladium (+). Her cutaneous symptoms are currently being managed conservatively and have shown a partial response to topical steroids. Revision surgery remains a long-term treatment option should conservative therapy fail; however, it would require a custom-made prosthesis as no standard tibial component is free from vanadium.

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“…An older study of 50 patients who underwent metal hinge arthroplasty of the knee showed no correlation between positive patch test reactions and loosening of the prosthesis [99]. A recent review of the literature by Middleton and Toms [100] arrived at the conclusion that although a relationship is present, they could not find any evidence of implant failure due to allergy. However, patient-reported allergy is found to be associated with decreased functional outcomes after TKA and decreased mental health scores after THA [101].…”

Section: Orthopedic Implantsmentioning

confidence: 97%

“…The authors hence arrived at the conclusion that patch testing is of little practical value in predicting medium-term clinical outcomes following TKA and should not be strongly recommended to guide the surgeon's selection of implant type. Middleton and Toms [100] concluded that although there is an association between metal allergy and implant failure, there is no evidence of a causal relationship and hence no justification for using "hypoallergenic" implants, thus indirectly supporting the stance that there is no need for preimplantation testing.…”

Section: Is There a Need For Allergy Testing Before Implantation?mentioning

confidence: 99%

“…In fact, Middleton et al [100] point out that diagnosis of implant-related allergy is almost impossible and requires the demonstration of abundant typical T lymphocytes in immunohistopathology, a positive patch test result to a specific implant-derived allergen, and improvement of symptoms upon replacement of the implant with an immunologically inert implant. Consequently, reaching a diagnosis of metal allergy is akin to putting the cart before the horse, as the patient would have to undergo implant removal regardless.…”

Section: Postimplantationmentioning

confidence: 99%

See 1 more Smart Citation

Hypersensitivity Reactions to Implanted Metal Devices: Facts and Fictions

2016

J Investig Allergol Clin Immunol

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The use of metals in the medical field has become increasingly prevalent over the past few decades. Patients find themselves being exposed to metals in a variety of ways, ranging from external exposure to instruments such as the stainless steel in surgical blades to internal exposure via medical devices being implanted in their bodies. There has been growing interest in the possibility of developing hypersensitivity reactions to constituent metals in medical implant devices, both in cutaneous and systemic forms. Hypersensitivity reactions to metals are uncommon, but they are reported and require appropriate evaluation and management, particularly if they are symptomatic. In view of the lack of consensus in the field on the appropriate steps to evaluate and manage patients with suspected metal hypersensitivity reactions, this review aims to analyze current evidence on hypersensitivity reactions to metallic implants in orthopedic surgery, endovascular surgery, obstetrics and gynecology, and dental surgery. Key words: Metal hypersensitivity. Metallic implants. ResumenEl empleo de metales dentro de la medicina ha ido aumentando de forma progresiva en las últimas décadas. Los pacientes se exponen a metales de diferentes formas desde fuentes externas, como instrumental quirúrgico como el presente en las hojas de acero de los bisturíes, hasta implantes metálicos. Como consecuencia de ello se está produciendo un interés creciente por la posibilidad de desarrollar reacciones de hipersensibilidad a metales presentes en los materiales y objetos implantados, tanto en forma de reacciones cutáneas como sistémicas. Las reacciones de hipersensibilidad a metales no son frecuentes, pero pueden desarrollarse, y por ello, requieren de un diagnóstico y tratamiento adecuado, especialmente en aquellos pacientes que desarrollen síntomas. No existe un consenso en el proceso diagnóstico ni en el tratamiento de estas reacciones en los pacientes con sospecha de alergia a metales. Esta revisión tiene por objeto actualizar la evidencia existente sobre las reacciones de hipersensibilidad a implantes metálicos en cirugía ortopédica, cirugía endovascular, cirugía obstétrica y ginecológica (OB-GYN) así como la dental. Palabras clave: Hipersensibilidad a metales. Implantes metálicos.

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Allergy in total knee arthroplasty

Cited by 88 publications

References 40 publications

Retrieval analysis of TiN (titanium nitride) coated knee replacements: Coating wear and degradation in vivo

Retrieval analysis of TiN (titanium nitride) coated knee replacements: Coating wear and degradation in vivo

Vanadium allergy following total knee arthroplasty

Hypersensitivity Reactions to Implanted Metal Devices: Facts and Fictions

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