Hypersensitivity to orthopaedic implant manifested as erythroderma: Timing of implant removal

Phedy, Phedy; Djaja, Yoshi Pratama; Boedijono, Dimas; Wahyudi, Muhammad; Silitonga, Jamot; Solichin, Iman

doi:10.1016/j.ijscr.2018.06.011

Cited by 8 publications

(10 citation statements)

References 29 publications

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“…Orthopedic implants are implanted into the human body in order to assist with carrying out the normal functions of the bone tissues and the joints and, as reported elsewhere [[1], [2], [3], [4], [5]], the implant materials may have to be removed if they are not comprised of biocompatible alloying elements. Nickel (Ni) is an alloying element that results in the most frequent allergic reactions among all alloying elements used in implant materials [6].…”

Section: Introductionmentioning

confidence: 99%

Effect of thermomechanical treatment on the mechanical and microstructural evolution of a β-type Ti-40.7Zr–24.8Nb alloy

Ozan

Lin²,

Weng

et al. 2019

Bioactive Materials

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In this study, the microstructural evolution and mechanical properties of a newly developed Ti-40.7Zr–24.8Nb (TZN) alloy after different thermomechanical processes were examined. As-cast TZN alloy plates were solution-treated at 890 °C for 1 h, after which the thickness of the alloy plates was reduced by cold rolling at reduction ratios of 20%, 56%, 76%, and 86%. Stress-induced α” formation, {332} <113> β mechanical twinning, and kink band formation were observed in the cold-rolled TZN alloy samples. In the TZN sample after cold rolling at the 86% reduction ratio plus a recrystallization annealing at 890 °C for 1 h, the deformation products of a stress-induced α” phase, {332}<113> β mechanical twinning, and kink bands disappeared, resulting in a fine, equiaxed single β phase. The alloy samples exhibited elongation at rupture ranging from 7% to 20%, Young's modulus ranging from 63 to 72 GPa and tensile strength ranging from 753 to 1158 MPa. The TZN alloy sample after cold rolling and recrystallization annealing showed a yield strength of 803 MPa, a tensile strength of 848 MPa, an elongation at rupture of 20%, and an elastic admissible strain of 1.22%, along with the most ductile fractures during tensile testing.

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Section: Introductionmentioning

confidence: 99%

Effect of thermomechanical treatment on the mechanical and microstructural evolution of a β-type Ti-40.7Zr–24.8Nb alloy

Ozan

Lin²,

Weng

et al. 2019

Bioactive Materials

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“…In certain case, SCD is also induced by various metal alloys applied in orthopaedical, cardiac, neurological, and abdominal associated devices [72]. In these cases, chromium-containing alloys such as stainless steel SAE 316 L, cobalt-chromium-molybdenum steel, and Vitalium™ release metal ion [73] are reported to cause SCD [74][75][76][77][78][79]. These reported SCD cases are identified with the presence of several manifestations including erythroderma [74], and localized/generalized eczema or urticarial [76][77][78].…”

Section: Systemic Contact Dermatitismentioning

confidence: 99%

“…Sharma developed a guideline for the preparation of low chromate diet that could help in controlling daily chromium consumption from food and ameliorating skin condition [82]. In case of SCD from arthroplastic routes, revision or removal of implant needs to be conducted by considering the time of hypersensitivity incidence after surgery and degree of severity [74]. Revision of implant could be conducted by using less allergenic implant such as titanium-based implant or chromium-based implant coated with certain biocompatible materials such as polytetrafluoroethylene, ZrN multilayers, diamond-like carbon, titanium nitride, graphite-like carbon, and tantalum [74,79,83].…”

Section: Systemic Contact Dermatitismentioning

confidence: 99%

“…In case of SCD from arthroplastic routes, revision or removal of implant needs to be conducted by considering the time of hypersensitivity incidence after surgery and degree of severity [74]. Revision of implant could be conducted by using less allergenic implant such as titanium-based implant or chromium-based implant coated with certain biocompatible materials such as polytetrafluoroethylene, ZrN multilayers, diamond-like carbon, titanium nitride, graphite-like carbon, and tantalum [74,79,83]. Revision or removal of implants may not produce rapid disappearance [76] probably due to the presence of soluble or particulate debris of implant that produce inflammations [84,85].…”

Section: Systemic Contact Dermatitismentioning

confidence: 99%

“…In different situations, the use of chromium-based skin clips [169] and orthopedic implant [74] gave an adverse effect by delaying surgery wound healing process. These cases represented a hypersensitivity effect as a manifestation of systemic contact dermatitis.…”

Section: Cutaneous Wound (Rapid Wound Healing)mentioning

confidence: 99%

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Dermatologic Toxicities and Biological Activities of Chromium

Jumina¹,

Harizal²

2021

Trace Metals in the Environment - New Approaches and Recent Advances

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Chromium is a versatile metal with various industrial applications and biological activities. However, as a transition metal, this element forms several species, i.e. oxidation states of −4 to +6, with different degrees of toxicities that affect ecosystems and organisms including human beings. The skin is the outermost organ that usually interacts directly with chromium species in nature. These contact and interaction induce the formation of several acute and chronic negative effects including contact dermatitis, skin cancer, allergy, etc. In this chapter, toxicity and biological activity of several chromium species, such as chromium zero-valent, trivalent, hexavalent, will be reviewed to obtain better comprehension in chromium toxicity. Sources and routes of exposure, toxicity and possible treatment, and biological activity on the skin are arranged and explained systematically.

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Systemic Effects of Metals Released from Arthroplasty Implants – a Brief Summary

Rakow

Schoon

2020

Z Orthop Unfall

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In recent years, increasing concern has been raised regarding potential systemic toxicity of metals released from arthroplasty implants. A lack of valid metal thresholds for human (organ) toxicity and the prospect of multi-decade survival of modern hip and knee replacements pose special challenges. Indeed, evidence of systemic effects of metals released from such implants is largely missing. Systemic cobalt exposure has repeatedly been associated with cardiotoxic and neurotoxic effects, and also with thyroid dysfunction. The toxic potential of chromium is considered less pronounced. Yet, in arthroplasty there is usually a co-exposure to chromium and cobalt which complicates evaluation of element-specific effects. Toxicity of titanium dioxide nanoparticles has been subject to debate among international regulatory authorities. Their wide use in a variety of products in everyday life, such as toothpaste, cosmetics and food colorants, hampers the assessment of an arthroplasty-induced systemic titanium exposure. To date there is no clear evidence for systemic complications due to titanium dioxide released from arthroplasty implants. Release of further metals such as tantalum, niobium, nickel, vanadium and zirconium from hip and knee replacement implants has been described occasionally, but systemic effects of respective long-term exposure scenarios are unknown. Generally, the characterization of all released metals regarding their chemical and physical specifications is critical for the evaluation of potential systemic risks. Systematic studies investigating the accumulation of metals relevant in arthroplasty in different organs/organ systems and the biological consequences of such accumulations are urgently needed.

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Hypersensitivity to orthopaedic implant manifested as erythroderma: Timing of implant removal

Cited by 8 publications

References 29 publications

Effect of thermomechanical treatment on the mechanical and microstructural evolution of a β-type Ti-40.7Zr–24.8Nb alloy

Effect of thermomechanical treatment on the mechanical and microstructural evolution of a β-type Ti-40.7Zr–24.8Nb alloy

Dermatologic Toxicities and Biological Activities of Chromium

Systemic Effects of Metals Released from Arthroplasty Implants – a Brief Summary

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