Allergy to Metals as a Cause of Orthopedic Implant Failure

Krêcisz, Beata; Kieć-Swierczyńska, M; Mitura, Katarzyna

doi:10.2478/v10001-006-0025-6

Cited by 32 publications

(24 citation statements)

References 13 publications

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“…In all those cases, the presence of sensitizing metals in the implants was confirmed. Also, the role of allergy to metal in implant failure was suggested in our previous observations [21] and in the study of German authors [8], who reported four cases of women with poor tolerance to knee implants (pain, recurrent effusions, symptoms of cutaneous metal intolerance). Those women were allergic to nickel and cobalt, but after switching to titanium-plated endoprosthesis they became symptom-free.…”

Section: Discussionmentioning

confidence: 99%

Allergy to orthopedic metal implants — A prospective study

Krêcisz

Kieć-Swierczyńska

Chomiczewska-Skóra

2012

International Journal of Occupational Medicine and Environmental Health

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Objectives: Evaluation of the allergenic properties of the metal knee or hip joint implants 24 months post surgery and assessment of the relation between allergy to metals and metal implants failure. Materials and Methods: The study was conducted in two stages. Stage I (pre-implantation) -60 patients scheduled for arthroplasty surgery. Personal interview, dermatological examination and patch testing with 0.5% potassium dichromate, 1.0% cobalt chloride, 5.0% nickel sulfate, 2.0% copper sulfate, 2.0% palladium chloride, 100% aluminum, 1% vanadium chloride, 5% vanadium, 10% titanium oxide, 5% molybdenum and 1% ammonium molybdate tetrahydrate were performed. Stage II (post-surgery) -48 subjects participated in the same procedures as those conducted in Stage I. Results: Stage I -symptoms of "metal dermatitis" were found in 21.7% of the subjects: 27.9% of the females, 5.9% of the males. Positive patch test results were found in 21.7% of the participants, namely to: nickel (20.0%); palladium (13.3%); cobalt (10.0%); and chromium (5.9%). The allergy to metals was confirmed by patch testing in 84.6% of the subjects with a history of metal dermatitis. Stage II -10.4% of the participants complained about implant intolerance, 4.2% of the examined persons reported skin lesions. Contact allergy to metals was found in 25.0% of the patients: nickel 20.8%, palladium 10.4%, cobalt 16.7%, chromium 8.3%, vanadium 2.1% Positive post-surgery patch tests results were observed in 10.4% of the patients. The statistical analysis of the pre-and post-surgery patch tests results showed that chromium and cobalt can be allergenic in implants. Conclusions: Metal orthopedic implants may be the primary cause of allergies. that may lead to implant failure. Patch tests screening should be obligatory prior to providing implants to patients reporting symptoms of metal dermatitis. People with confirmed allergies to metals should be provided with implants free from allergenic metals.

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Section: Discussionmentioning

confidence: 99%

Allergy to orthopedic metal implants — A prospective study

Krêcisz

Kieć-Swierczyńska

Chomiczewska-Skóra

2012

International Journal of Occupational Medicine and Environmental Health

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“…In 17 retrospective studies, two series reported on revisions for implant allergies [35,61]. Thomas et al [61] analyzed periprosthetic tissue in TKA revisions for suspected metal allergy.…”

Section: Resultsmentioning

confidence: 99%

“…In nine of 16 retrospective studies, patch testing was used [17,19,33,35,45,51,52,54,61]. In one study, diagnostic procedures also included LTT, ELISA, and confocal microscopy [33].…”

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%

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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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“…Darüber hinaus gibt es einige wenige Epikutantestuntersuchungen mit Vanadiumtrichlorid [Vanadium(III)-chlorid] in unterschiedlichen Konzentrationen und Vehikeln. Auch hier wurden nur einzelne positive Reaktionen von unklarer Relevanz beobachtet [10]. Man kann also auch im Falle von Vanadiumverbindungen nicht davon ausgehen, dass eine geeignete und ausreichend geprüfte Testsubstanz für die Epikutantestung zur Verfügung steht.…”

Section: Titanunclassified