Allergy in Total Knee Replacement. Does It Exist?

Abstract

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.

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

“…Beside infections, other implant‐related complications such as malalignment, loosening, skin changes, pain and swelling may occur. One potential cause that has been widely discussed is a hypersensitivity reaction to a metal or bone cement component . According to case reports, allergic reactions to such materials have been rarely described .…”

“…One potential cause that has been widely discussed is a hypersensitivity reaction to a metal or bone cement component. [6][7][8][9][10][11][12][13][14][15] According to case reports, allergic reactions to such materials have been rarely described. [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] Larger studies evaluated potential allergens and hypersensitivity prevalences after TJA, and tried to establish general preoperative (PO) and postoperative guidelines in cases of suspected metal hypersensitivity.…”

Metal duyarlılığı ve metalloz

“…Metal hipersensitivitesine ilişkin güvenilir bulgular vermemektedir. [19] Alerji Testleri: Ne Zaman, Hangi Test?…”

“…Özellikle metalik implant-eklem protezi bölgesinde gelişen enfeksiyon, ortopedistlerin oldukça çekindikleri, tanı ve tedavisinde güçlük çektikleri, zaman zaman metal alerjisi sorunlarından ayırt edilmesinin oldukça güç olduğu ancak metal alerjisine oranla çok daha sık olarak görülen bir komplikasyondur. [19] Eklem protezlerinin aksine, kırık tespiti amacıyla kullanılan metalik implantlara karşı hipersensitivite reaksiyonları çok daha az sıklıkta görülmektedir. Bunun başlıca nedeni; bu implantların herhangi bir harekete sahip olmamalarıdır.…”

“…ALVAL ve psödotümör gibi yumuşak doku ağırlıklı lezyonların 31 çalışmanın 28'i bu testin altın standart olduğunu ortaya koymaktadır. [19] Metal hipersensitivitesinin tanısı iki dönemde önem taşımaktadır. İlki; metalik bir implant yerleştirilecek kişide bu işlem öncesinde var olan ve ileride sorun oluşturabilecek metal duyarlılığının belirlenmesi; diğeri de metalik implant yerleştirildikten sonra ona karşı gelişmiş olan duyarlılığın ve alerjik reaksiyonların tanısının konmasıdır.…”