Autoantibodies to red cells associated with metallosis—a case report

Nakamura, Seigo; Yasunaga, Yuji; Ikuta, Yoshikazu; Shimogaki, Kouichi; Hamada, Norikazu; Takata, Noboru

doi:10.3109/17453679708996269

Cited by 18 publications

(4 citation statements)

References 4 publications

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“… 153 , 156 , 158 – 160 , 169 Some of these reactions of severe dermatitis, 139 , 155 , 158 , 170 urticaria (intensely sensitive and itching red round wheels on the skin), 154 , 169 and/or vasculitis (patch inflammation of the walls of small blood vessels) have been linked with the relatively more general phenomena of metallosis, excessive periprosthetic fibrosis, and muscular necrosis. 160 , 171 , 172 Generally, there are more case reports of hypersensitivity reactions associated with stainless steel and cobalt alloy implants than with titanium alloy components. 128 , 157 – 159 , 169 , 170 , 173 , 174 …”

Section: Resultsmentioning

confidence: 99%

A review of the biologic effects of spine implant debris: Fact from fiction

Hallab¹

2009

SAS Journal

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BackgroundBiologic-reactivity to implant-debris is the primary determinant of long-term clinical performance. The following reviews: 1) the physical aspects of spinal-implant debris and 2) the local and systemic biologic responses to implant debris.MethodsMethods included are: 1) gravimetric wear analysis; 2) SEM and LALLS; 3) metal-ion analysis; 4) ELISA, toxicity testing, patch testing; and 5) metal-lymphocyte transformation testing (metal-LTT).ResultsWear and corrosion of spine-implants produce particles and ions. Particles (0.01–1000 μm) are generally submicron ( <1 µm). Wear rates of metal-on-polymer and metal-on-metal disc arthroplasties are approximately 2–20 and 1 mm3/yr, respectively. Metal-on-metal total disc replacement components have significant increases in circulating metal (less than 10-fold that of controls at 4 ppb-Co and 3 ppb-Cr or ng/mL). Debris reactivity is local and systemic. Local inflammation is caused primarily by ingestion of debris by local macrophages, which produce pro-inflammatory cytokines TNFα, IL-1β, IL-6, and PGE2. Systemic responses associated with implant-debris have been limited to hypersensitivity reactions. Elevated amounts of in the liver, spleen, etc of patients with failed TJA have not been associated with remote toxicological or carcinogenic pathology to date. Implant debris are differentially bioreactive. Greater numbers are pro-inflammatory; the smaller-sized debris are more bioreactive by virtue of their greater numbers (dose) for a given amount of implant mass loss (one 100-μm-diameter particle is equivalent in mass to 1 million 1-μm-diameter particles). Elongated particles are pro-inflammatory (ie, aspect ratio of greater than 3). Metal particles are more proinflammatory than polymers, ceteris paribus.ConclusionSpinal arthroplasty designs have been in use for more than 20 years internationally; therefore, concerns about neuropathology, toxicity, and carcinogenicity are mitigated. Debris-induced inflammation still depends on the individual and the type of debris. The consequence of debris-induced inflammation is continued; vigilance by physicians is recommended monitoring of spinal implants using physical exams and testing of metal content and bioreactivity, as is planning for the likelihood of revision in younger individuals.

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Section: Resultsmentioning

confidence: 99%

A review of the biologic effects of spine implant debris: Fact from fiction

Hallab¹

2009

SAS Journal

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“…También pueden ocurrir otras reacciones adversas que incluyen disfunción del dispositivo, inflamación crónica, dolor y aflojamiento de prótesis articulares [38]. En algunos casos, también se han notificado metalosis (tinción metálica del tejido circundante), fibrosis periprotésica excesiva y necrosis muscular [39].…”

Section: Tratamientounclassified

Complicaciones dermatológicas no infecciosas de los implantes ortopédicos: una revisión de la literatura

Macía

Fino²

2021

archmed

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Introducción: la prevalencia general de hipersensibilidad a los componentes metálicos ortopédicos se ha calculado en aproximadamente de 10 al 15%. Objetivo: describir las reacciones de hipersensibilidad secundarias a la implantación de dispositivos protésicos ortopédicos en cirugía de artroplastia. Materiales y métodos: se realizó una búsqueda abierta en las bases de datos EBSCO, PubMed-Medline, Google académico, SciELO, Embase biomedical y Cochrane Library con los términos: arthroplastym, hypersensitivity, prostheses e implants, en inglés y español, sin limitación del grado de evidencia. Resultados: se encontraron 39 artículos con información relevante para la actual revisión. Conclusiones: las reacciones cutáneas de hipersensibilidad al metal son infrecuentes, por lo que deben excluirse causas inflamatorias más comunes como la infección, inestabilidad, aflojamiento o malrotación del implante, entre otras, antes de considerar tal patología. Actualmente no existe un estándar de oro respecto al diagnóstico, tratamiento o prevención de la hipersensibilidad.

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“…Other adverse reactions including device failure, chronic inflammation, pain, loosening of joint prostheses or re-stenosis of cardiac stents can also occur [20]. In some cases, metallosis (metallic staining of the surrounding tissue), excessive periprosthetic fibrosis and muscular necrosis have also been reported [21–23]. …”

Section: Introductionmentioning

confidence: 99%

Metal Hypersensitivity Reactions to Orthopedic Implants

Teo

Schalock

2016

Dermatol Ther (Heidelb)

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Total hip and knee replacement surgery using metal alloy devices is common. Type IV allergic reactions to these implants occur, though infrequently. While uncommon, peri-implant metal allergic reactions may cause significant morbidity for the affected individual—including aseptic loosening, pseudotumor formation and frank device failure. It is challenging to predict who will have these reactions, even in those with established pre-implant metal allergy. At this time, the scientific literature clearly supports few conclusions. Despite this, we believe several conclusions can be made: routine pre-implant testing in asymptomatic individuals is not indicated; listen to patient’s concerns about metal allergy if the concern arises; patch testing is probably the best pre- and post-implant screening test; post-implantation testing is controversial and even positive LTT or patch test does not definitively diagnose morbidity from a metal allergy; and complete recovery following revision placement of an immunologically inert device is diagnostic. More research is needed to scientifically approach this issue.

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Autoantibodies to red cells associated with metallosis—a case report

Cited by 18 publications

References 4 publications

A review of the biologic effects of spine implant debris: Fact from fiction

A review of the biologic effects of spine implant debris: Fact from fiction

Complicaciones dermatológicas no infecciosas de los implantes ortopédicos: una revisión de la literatura

Metal Hypersensitivity Reactions to Orthopedic Implants

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