Metal Sensitivity in Patients with Metal-To-Plastic Total hip Arthroplasties

Carlsson, Åke; Magnusson, Bertil; Möller, Halvor

doi:10.3109/17453678008990769

Cited by 108 publications

(45 citation statements)

References 13 publications

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“…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.…”

mentioning

confidence: 99%

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

Cadosch

Sutanto

Chan

et al. 2009

Journal Orthopaedic Research

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There is increasing evidence that titanium ions are released from orthopedic implants by biocorrosion. The aim of this study was to investigate titanium uptake by human T-lymphocytes and its effects on phenotype and proliferation. Freshly isolated human nonadherent peripheral blood mononuclear cells (NA-PBMC), were exposed to TiCl 4 [Ti(IV)]. Bioavailability and distribution of Ti(IV) in T-lymphocytes was determined by energy-filtered electron microscopy (EFTEM). The effects of Ti(IV) challenge on nonactivated and PHA-activated cells were assessed by flow cytometric analysis of surface markers, RANK-L production, and proliferation assays. EFTEM colocalized Ti(IV) with phosphorus in the nucleus, ribosomes, cytoplasmic membranes, and the surface membrane of T-lymphocytes. Ti(IV) increased significantly the expression of CD69, CCR4, and RANK-L in a concentration-dependent manner. Titanium enters T-lymphocytes through a currently unknown mechanism and binds to phosphorus-rich cell structures. Titanium influences phenotype and function of T-lymphocytes, resulting in activation of a CD69þ and CCR4þ T-lymphocyte population and secretion of RANK-L. These results strongly suggest the involvement of titanium ions challenged T-lymphocytes in the complex pathophysiological mechanisms of aseptic loosening of orthopedic implants. ß

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mentioning

confidence: 99%

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

Cadosch

Sutanto

Chan

et al. 2009

Journal Orthopaedic Research

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“…The number of prospective studies is limited and the results differ. For example: in one examination it was shown that only 3 out of 112 (2.7%) patients with metal-to-metal total hip arthroplasties were allergic to metals [16]. In other studies, 5 out of 72 (6.9%) patients developed allergic reactions to at least one or more metals that were included in the orthopedic not to contain allergenic metals to which the patients were sensitized.…”

Section: Discussionmentioning

confidence: 99%

Allergy to orthopedic metal implants — A prospective study

Krêcisz

Kieć-Swierczyńska

Chomiczewska-Skóra

2012

International Journal of Occupational Medicine and Environmental Health

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Objectives: Evaluation of the allergenic properties of the metal knee or hip joint implants 24 months post surgery and assessment of the relation between allergy to metals and metal implants failure. Materials and Methods: The study was conducted in two stages. Stage I (pre-implantation) -60 patients scheduled for arthroplasty surgery. Personal interview, dermatological examination and patch testing with 0.5% potassium dichromate, 1.0% cobalt chloride, 5.0% nickel sulfate, 2.0% copper sulfate, 2.0% palladium chloride, 100% aluminum, 1% vanadium chloride, 5% vanadium, 10% titanium oxide, 5% molybdenum and 1% ammonium molybdate tetrahydrate were performed. Stage II (post-surgery) -48 subjects participated in the same procedures as those conducted in Stage I. Results: Stage I -symptoms of "metal dermatitis" were found in 21.7% of the subjects: 27.9% of the females, 5.9% of the males. Positive patch test results were found in 21.7% of the participants, namely to: nickel (20.0%); palladium (13.3%); cobalt (10.0%); and chromium (5.9%). The allergy to metals was confirmed by patch testing in 84.6% of the subjects with a history of metal dermatitis. Stage II -10.4% of the participants complained about implant intolerance, 4.2% of the examined persons reported skin lesions. Contact allergy to metals was found in 25.0% of the patients: nickel 20.8%, palladium 10.4%, cobalt 16.7%, chromium 8.3%, vanadium 2.1% Positive post-surgery patch tests results were observed in 10.4% of the patients. The statistical analysis of the pre-and post-surgery patch tests results showed that chromium and cobalt can be allergenic in implants. Conclusions: Metal orthopedic implants may be the primary cause of allergies. that may lead to implant failure. Patch tests screening should be obligatory prior to providing implants to patients reporting symptoms of metal dermatitis. People with confirmed allergies to metals should be provided with implants free from allergenic metals.

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“…When this degradative process is severe enough it can damage the structural integrity of the implant, and corrosion products are potentially toxic. 1,[5][6][7]9,14,16,18,24,33,37,46,49,50,56,57,[59][60][61][62][63][64]70 Disc replacement designs incorporate cobalt-chromium-molybdenum alloy endplates that are externally coated with titanium for bone ingrowth. The metallic endplates are fixed to polymeric cores and motion takes place between articulating polymer surfaces.…”

Section: Biomaterials Used In Joint Replacementmentioning

confidence: 99%

The future of spinal arthroplasty: a biomaterial perspective

Oskouian

Whitehill²,

Samii³

et al. 2004

FOC

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Both total hip and knee arthroplasty have demonstrated outstanding clinical results. The functional spinal unit composed of the intervertebral disc and facet joints is at least as complex. The intricacies of the coupled motions of the functional spinal unit have made development of an artificial disc a challenge. There have been several failed attempts to create a disc replacement that recapitulates normal motion while providing significant longevity and a low incidence of complications. Better understanding of the biomechanics of the intervertebral disc complex and improvements in implant material have made successful intervertebral disc replacement a likely reality, now that several artificial discs have completed Food and Drug Administration clinical trials. In this manuscript the authors detail the biomaterials used in disc arthroplasty and discuss joint wear and the host response to wear debris.

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Metal Sensitivity in Patients with Metal-To-Plastic Total hip Arthroplasties

Cited by 108 publications

References 13 publications

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

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

Allergy to orthopedic metal implants — A prospective study

The future of spinal arthroplasty: a biomaterial perspective

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