No Increased Risk of Knee Arthroplasty Failure in Patients With Positive Skin Patch Testing for Metal Hypersensitivity: A Matched Cohort Study

Bravo, Dalibel; Wagner, Eric R.; Larson, Dirk R.; Davis, Mark P.; Pagnano, Mark W.; Sierra, Rafael J.

doi:10.1016/j.arth.2016.01.024

Cited by 72 publications

(45 citation statements)

References 14 publications

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“…As reported by Merritt and Rodrigo3), it is difficult to determine whether an allergy should be considered as a cause or an effect. Also, Bravo et al5) did not find any significant relation between total knee arthroplasty failure and a positive skin patch for metal allergy and did not confirm the etiology.…”

Section: Discussionmentioning

confidence: 92%

The Migratory Cortical Button: A Rare Case of Hypersensitivity to Titanium after an Anterior Cruciate Ligament Reconstruction

Bouguennec

Colombet

Graveleau

et al. 2019

Knee Surg Relat Res

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Section: Discussionmentioning

confidence: 92%

The Migratory Cortical Button: A Rare Case of Hypersensitivity to Titanium after an Anterior Cruciate Ligament Reconstruction

Bouguennec

Colombet

Graveleau

et al. 2019

Knee Surg Relat Res

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“…A correlation with metal allergy and device failure is not certain. A cohort study of 127 patients with 161 TKA compared to 161 control knee arthroplasty revealed that those with patch test positives to metal had similar complication, reoperation or revision rates when compared to those without allergy/matched controls [41]. Rates of post-operative pain were similar in those with metal allergy determined by patch testing, compared to control patients.…”

Section: The Association Between Orthopedic Implants and Metal Hypersmentioning

confidence: 99%

“…A cohort study of 127 patients with 161 TKA (56 patients with patch test positives) versus 161 matched control TKAs without known metal allergy history or positive patch testing were followed over a period of 5.3 years [41]. Most interestingly, those with patch test positives had similar reoperation, revision or complication rates in comparison to those with a normal skin patch testing as well as matched controls.…”

Section: The Debate Surrounding Appropriate Testingmentioning

confidence: 99%

Metal Hypersensitivity Reactions to Orthopedic Implants

Teo

Schalock

2016

Dermatol Ther (Heidelb)

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Total hip and knee replacement surgery using metal alloy devices is common. Type IV allergic reactions to these implants occur, though infrequently. While uncommon, peri-implant metal allergic reactions may cause significant morbidity for the affected individual—including aseptic loosening, pseudotumor formation and frank device failure. It is challenging to predict who will have these reactions, even in those with established pre-implant metal allergy. At this time, the scientific literature clearly supports few conclusions. Despite this, we believe several conclusions can be made: routine pre-implant testing in asymptomatic individuals is not indicated; listen to patient’s concerns about metal allergy if the concern arises; patch testing is probably the best pre- and post-implant screening test; post-implantation testing is controversial and even positive LTT or patch test does not definitively diagnose morbidity from a metal allergy; and complete recovery following revision placement of an immunologically inert device is diagnostic. More research is needed to scientifically approach this issue.

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“…There are also studies that strongly dispute the link between metal hypersensitivity and implant failure. A recent matched cohort study by Bravo et al [98] of 127 patients with 161 TKAs and 161 control knee arthroplasties showed that patients with a positive patch test result did not have higher complication, reoperation, or revision rates than patients with a negative patch test result and matched controls. The authors did not find any statistically significant difference in postoperative pain between patients with positive and negative skin patch results and controls.…”

Section: Orthopedic Implantsmentioning

confidence: 99%

“…Razak et al [219] performed a Delphi consensus study amongst joint arthroplasty experts and concluded that standard cobalt chromium/stainless steel implants should be used regardless of the patient's metal allergy status. In a matched cohort study performed over 5.3 years, 127 patients with 161 TKAs (56 patients had positive skin patch test results) were compared with 161 matched control TKAs with no history of metal allergy and no skin patch testing [98]. Most notably, patients with a positive patch test result did not have higher complication, reoperation, or revision rates than patients with a negative patch test result and matched controls, and there was no statistically significant difference in postoperative pain between patients with positive or negative patch test results and matched controls.…”

Section: Is There a Need For Allergy Testing Before Implantation?mentioning

confidence: 99%

Hypersensitivity Reactions to Implanted Metal Devices: Facts and Fictions

2016

J Investig Allergol Clin Immunol

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The use of metals in the medical field has become increasingly prevalent over the past few decades. Patients find themselves being exposed to metals in a variety of ways, ranging from external exposure to instruments such as the stainless steel in surgical blades to internal exposure via medical devices being implanted in their bodies. There has been growing interest in the possibility of developing hypersensitivity reactions to constituent metals in medical implant devices, both in cutaneous and systemic forms. Hypersensitivity reactions to metals are uncommon, but they are reported and require appropriate evaluation and management, particularly if they are symptomatic. In view of the lack of consensus in the field on the appropriate steps to evaluate and manage patients with suspected metal hypersensitivity reactions, this review aims to analyze current evidence on hypersensitivity reactions to metallic implants in orthopedic surgery, endovascular surgery, obstetrics and gynecology, and dental surgery. Key words: Metal hypersensitivity. Metallic implants. ResumenEl empleo de metales dentro de la medicina ha ido aumentando de forma progresiva en las últimas décadas. Los pacientes se exponen a metales de diferentes formas desde fuentes externas, como instrumental quirúrgico como el presente en las hojas de acero de los bisturíes, hasta implantes metálicos. Como consecuencia de ello se está produciendo un interés creciente por la posibilidad de desarrollar reacciones de hipersensibilidad a metales presentes en los materiales y objetos implantados, tanto en forma de reacciones cutáneas como sistémicas. Las reacciones de hipersensibilidad a metales no son frecuentes, pero pueden desarrollarse, y por ello, requieren de un diagnóstico y tratamiento adecuado, especialmente en aquellos pacientes que desarrollen síntomas. No existe un consenso en el proceso diagnóstico ni en el tratamiento de estas reacciones en los pacientes con sospecha de alergia a metales. Esta revisión tiene por objeto actualizar la evidencia existente sobre las reacciones de hipersensibilidad a implantes metálicos en cirugía ortopédica, cirugía endovascular, cirugía obstétrica y ginecológica (OB-GYN) así como la dental. Palabras clave: Hipersensibilidad a metales. Implantes metálicos.

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No Increased Risk of Knee Arthroplasty Failure in Patients With Positive Skin Patch Testing for Metal Hypersensitivity: A Matched Cohort Study

Cited by 72 publications

References 14 publications

The Migratory Cortical Button: A Rare Case of Hypersensitivity to Titanium after an Anterior Cruciate Ligament Reconstruction

The Migratory Cortical Button: A Rare Case of Hypersensitivity to Titanium after an Anterior Cruciate Ligament Reconstruction

Metal Hypersensitivity Reactions to Orthopedic Implants

Hypersensitivity Reactions to Implanted Metal Devices: Facts and Fictions

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