Failure of a Medial Unicompartmental Knee Replacement due to Metal Allergy

Apostolopoulos, Alexandros P; Balfousias, Theodore; Khan, S.; Srikanth, B.; Tselentakis, George

doi:10.1615/jlongtermeffmedimplants.2019030060

Cited by 3 publications

(2 citation statements)

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“…There were nine case reports of patients with symptomatic TKAs and metal allergies revised to hypoallergenic rTKA components with resolution of symptoms. 45 - 53 Two further cases reported on pharmacological treatments with topical steroids 54 and oral omalizumab (recombinant, monoclonal antibody against human immunoglobulin IgE). 55 …”

Section: Resultsmentioning

confidence: 99%

Metal allergy in primary and revision total knee arthroplasty

Matar

Porter

2021

Bone & Joint Open

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Aims Metal allergy in knee arthroplasty patients is a controversial topic. We aimed to conduct a scoping review to clarify the management of metal allergy in primary and revision total knee arthroplasty (TKA). Methods Studies were identified by searching electronic databases: Cochrane Central Register of Controlled Trials, Ovid MEDLINE, and Embase, from their inception to November 2020, for studies evaluating TKA patients with metal hypersensitivity/allergy. All studies reporting on diagnosing or managing metal hypersensitivity in TKA were included. Data were extracted and summarized based on study design, study population, interventions and outcomes. A practical guide is then formulated based on the available evidence. Results We included 38 heterogeneous studies (two randomized controlled trials, six comparative studies, 19 case series, and 11 case reports). The evidence indicates that metal hypersensitivity is a rare complication with some histopathological features leading to pain and dissatisfaction with no reliable screening tests preoperatively. Hypoallergenic implants are viable alternatives for patients with self-reported/confirmed metal hypersensitivity if declared preoperatively; however, concerns remain over their long-term outcomes with ceramic implants outperforming titanium nitride-coated implants and informed consent is paramount. For patients presenting with painful TKA, metal hypersensitivity is a diagnosis of exclusion where patch skin testing, lymphocyte transformation test, and synovial biopsies are useful adjuncts before revision surgery is undertaken to hypoallergenic implants with shared decision-making and informed consent. Conclusion Using the limited available evidence in the literature, we provide a practical approach to metal hypersensitivity in TKA patients. Future national/registry-based studies are needed to identify the scale of metal hypersensitivity, agreed diagnostic criteria, and management strategies. Cite this article: Bone Jt Open 2021;2(10):785–795.

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Section: Resultsmentioning

confidence: 99%

Metal allergy in primary and revision total knee arthroplasty

Matar

Porter

2021

Bone & Joint Open

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“…In this patient, the tibial component was found to be loose, and the polyethylene bearing dislocated posteriorly. The same authors performed revision surgery for UKA failure due to allergic reactions to a TKA using an oxinium implant, identifying a positive reaction to a nickel lymphocyte proliferation skin allergy test ( 26 ). A similar case was reported by Bergschmidt et al ( 27 ), involving a 58-year-old female patient with type IV hypersensitivity against both the nickel-II-sulfate and palladium chloride used during a TKA.…”

Section: Discussionmentioning

confidence: 99%

High early failure rate for a new unicondylar knee system

Araújo¹,

Freitag²,

Kamath³

et al. 2023

Ann Joint

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Background This single-center retrospective study evaluated early failure rates for an unicompartmental knee arthroplasty (UKA) system with an anti-allergic surface. Methods We studied 87 consecutive joints received an UKA at a single center between 2017 and 2020. All patients received a fully cemented anti-allergic Univation-Aesculap partial knee replacement implant with a corundum blasting surface. All joints had precise indication of unicompartmental arthroplasty according to the current criteria of this procedure. The current series was restricted to patients undergoing medial cemented UKA. Medial compartment osteoarthritis was the main indication. Results We found early failure (aseptic loosening) was documented in 20 of the 87 joints (23%). The time to failure ranged from 7 weeks to 3 years, for an estimated 33% (15–46%) cumulative hazard rate for implant loosening over three years. No cases of periprosthetic joint infection were found. On average, the patients began complaining about first symptoms during the third month after surgery. In most cases (66.66%), the cement remained fixed to the bone. Conclusions Based on these early results, the manufacturer of this implant stopped all further distribution. Continued efforts should be made to understand the clinical and radiographic outcomes of alternative and anti-allergic surface coatings in knee arthroplasty.

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Advantages and limitations of mobile-bearing unicompartmental knee arthroplasty: an overview of the literature

Hiranaka

2024

Expert Review of Medical Devices

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Failure of a Medial Unicompartmental Knee Replacement due to Metal Allergy

Cited by 3 publications

References 0 publications

Metal allergy in primary and revision total knee arthroplasty

Metal allergy in primary and revision total knee arthroplasty

High early failure rate for a new unicondylar knee system

Advantages and limitations of mobile-bearing unicompartmental knee arthroplasty: an overview of the literature

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