Cutaneous complications of orthopedic implants. A two-year prospective study

Abstract

In a two-year prospective study of cutaneous problems in orthopedic implant recipients, cutaneous eruptions of unknown cause that bore good temporal relationships with implant surgery occurred in 19 patients. Two clinical patterns were observed. A transient "exanthematic" dermatitis was seen in six patients; in two of them, it recurred after each surgical implant procedure. A persistent reaction was seen in 13 patients. Metal sensitivity was found in two patients and considered to be relevant. Allergic cutaneous complications of orthopedic implants are rare. However, in an implant recipient in whom a cutaneous problem develops, the likelihood of the cutaneous problem being allergic in nature is slightly greater if the implant is of the static type, if there is a history of metal sensitivity, if the cutaneous eruption shows a predilection for the anatomic zone of the implant, and if the eruption is eczematous and has developed late and persisted.

Titanium uptake, induction of RANK‐L expression, and enhanced proliferation of human T‐lymphocytes

“…Most patients tolerate orthopedic metal implants well; however, complications resulting from immune reactivity to metals have been well documented. [1][2][3][4][5][6] Dermal hypersensitivity to metal is common, with up to 20% of Caucasians being sensitive to nickel. 7 Immune reactions to dermal contact and ingestion of metals, manifested as skin conditions such as eczema, urticaria, erythema, and pruritis, are believed to be of a type IV cell-mediated hypersensitivity.…”

Retrospective Evaluation of Patch Testing Before or After Metal Device Implantation

“…Over the past decade, evidence has accumulated to support this concern. [1][2][3][4][5][6][7] Patch testing is one possible method for detecting an allergy to an implanted device. The efficacy of such testing in the case of metal sensitivity and implantable devices is a matter of considerable debate.…”

Rejection reaction to stabilizing bolts after ACL reconstruction: a case report

“…In an implant recipient, the likelihood of the cutaneous problem being allergic in nature, is slightly greater if the implant is of the static type, if the eruption shows a predilection for the anatomic zone of the implant and has developed late and persisted [15]. Implant materials and their degradation products interact with the surrounding physiologic environment and may elicit a local host response that influences clinical outcome of surgical reconstruction [3].…”