Cutaneous and Systemic Hypersensitivity Reactions to Metallic Implants

Basko-Plluska, Juliana; Thyssen, Jacob P.; Schalock, Peter C.

doi:10.2310/6620.2011.10055

Cited by 187 publications

(154 citation statements)

References 105 publications

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“…All metal prostheses, in particular MoM gliding surface and junctions, can release metal ions following tribocorrosion in body fluids and these might fuel allergic reactions [89]. Hypersensitivity can be defined as an abnormal immunological reaction upon exposure to a specific substance [90, 91]. In contrast to toxic reactions, there is no simple dose-response relationship, with higher doses being more potent than lower doses, because even small amounts of allergen can cause strong reactions, i.e.…”

Section: Biological Theories Of Periprosthetic Osteolysismentioning

confidence: 99%

Osteolysis around total knee arthroplasty: A review of pathogenetic mechanisms

et al. 2013

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Aseptic loosening and other wear-related complications are one of the most frequent late reasons for revision of total knee arthroplasty (TKA). Periprosthetic osteolysis (PPOL) predates aseptic loosening in many cases indicating the clinical significance of this pathogenic mechanism. A variety of implant-, surgery-, and host-related factors have been delineated to explain the development of PPOL. These factors influence the development of PPOL due to changes in mechanical stresses within the vicinity of the prosthetic device, excessive wear of the polyethylene liner, and joint fluid pressure and flow acting on the peri-implant bone. The process of aseptic loosening is initially governed by factors such as implant/limb alignment, device fixation quality, and muscle coordination/strength. Later large numbers of wear particles detached from TKAs trigger and perpetuate particle disease, as highlighted by progressive growth of inflammatory/granulomatous tissue around the joint cavity. An increased accumulation of osteoclasts at the bone-implant interface, an impairment of osteoblast function, mechanical stresses, and an increased production of joint fluid contribute to bone resorption and subsequent loosening of the implant. In addition, hypersensitivity and adverse reactions to metal debris may contribute to aseptic TKA failure but should be determined more precisely. Patient activity level appears to be the most important factor when the long-term development of PPOL is considered. Surgical technique, implant design, and material factors are the most important preventative factors because they influence both the generation of wear debris and excessive mechanical stresses. New generations of bearing surfaces and designs for TKA should carefully address these important issues in extensive preclinical studies. Currently, there is little evidence that PPOL can be prevented with pharmacological interventions.

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Section: Biological Theories Of Periprosthetic Osteolysismentioning

confidence: 99%

Osteolysis around total knee arthroplasty: A review of pathogenetic mechanisms

et al. 2013

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“…The presence of small amounts of debris that can be removed through catabolic processes is consistent with biological tolerance of implants [8, 9], while high concentrations of free metal ions may be accumulated in the surrounding tissue, or carried through the bloodstream to distant organs [10, 11]. Metal particles bind to serum proteins to form hapten-like complexes that may be identified by the immune system as antigens, and can activate local or systemic inflammatory reactions by recruiting macrophages, fibroblasts, lymphocytes, and osteoclasts, which induce proinflammatory and osteoclastogenic cytokine release [12].…”

Section: Introductionmentioning

confidence: 92%

Hypersensitivity reactions to metal implants: laboratory options

Carossino

Carulli

Ciuffi

et al. 2016

BMC Musculoskelet Disord

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BackgroundAll implant compounds undergo an electrochemical process when in contact with biological fluids, as well as mechanical corrosion due to abrasive wear, with production of metal debris that may inhibit repair processes. None of the commonly-used methods can diagnose implant allergies when used singly, therefore a panel of tests should be performed on allergic patients as pre-operative screening, or when a postoperative metal sensitisation is suspected.MethodsWe analysed patients with painful prostheses and subjects prone to allergies using the Patch Test in comparison with the Lymphocyte Transformation Test. Cytokine production was evaluated to identify prognostic markers for early diagnosis of aseptic loosening. Metal debris endocytosis and cytoskeletal rearrangement was visualised by confocal microscopy.ResultsOur results demonstrate that the Lymphocyte Transformation Test can identify patients who have a predisposition to develop allergic reactions and can confirm the diagnosis of hypersensitivity in patients with painful prostheses.The prevalence of a Th2-cytokine pattern may be used to identify predisposition to the development of allergic diseases, while the selective presence of osteoclastogenic cytokines may be used as predictor of a negative outcome in patients with painful prosthesis.The hypothesis of the prognostic value of these cytokines as early markers of aseptic loosening is attractive, but its confirmation would require extensive testing.ConclusionsThe Lymphocyte Transformation Test is the most suitable method for testing systemic allergies. We suggest that the combined use of the Patch Test and the Lymphocyte Transformation Test, associated with cytokine detection in selected patients, could provide a useful tool for preventive evaluation of immune reactivity in patients undergoing primary joint replacement surgery, and for clinical monitoring of the possible onset of a metal sensitization in patients with implanted devices.

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“…3 These allergies can be incited by a wide variety of consumer goods, such as jewelry or phones, and occupational exposures, as would occur in mining or construction industries, for example. 4 However, cutaneous reactivity to metal prosthetics is relatively uncommon.…”

Section: Diagnosismentioning

confidence: 99%