Patient Reported Allergies Are a Risk Factor for Poor Outcomes in Total Hip and Knee Arthroplasty

Graves, Christopher; Otero, Jesse E.; Gao, Yubo; Goetz, Devon D.; Willenborg, Melissa D.; Callaghan, John J.

doi:10.1016/j.arth.2014.02.040

Cited by 47 publications

(48 citation statements)

References 12 publications

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“…Earlier studies report similar findings, ie, multiple, patient-reported allergies may be a surrogate for mental health factors that negatively impact postoperative morbidity and functional and psychosocial outcomes [223][224][225]. Graves et al [226] followed 459 patients undergoing THA or TKA and found that patients who reported ≥4 allergies had less improvement in functional outcomes (using Western Ontario and McMaster Universities Arthritis Index function scores) than those who reported having <3 allergies. Given that one of the strongest predictors of patient satisfaction following TKA is meeting preoperative expectations [227], making efforts to establish patients' self-reported metal allergy status can contribute meaningfully to the tailoring of the management plan.…”

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

confidence: 48%

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

confidence: 48%

Hypersensitivity Reactions to Implanted Metal Devices: Facts and Fictions

2016

J Investig Allergol Clin Immunol

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“…Prior observational studies regarding multiple drug intolerance syndrome identified patients with this diagnosis as older, heavier (higher BMI), and more likely female. 15 While BMI was not significantly different between cohorts in our analysis, the study by Graves et al 5 did not compare BMI as an independent variable, which could allow for potential confounding. If the multiple allergy cohort resembles what is typical based on prior observations, the presence of obesity may explain the worse outcomes identified.…”

Section: Discussionmentioning

confidence: 62%

“…Graves et al 5 recently reported that patients with 4 or more reported allergies had less improvement in outcome measures after hip and knee replacement surgery. The authors argued that multiple reported allergies may function as a surrogate for a mental health survey and assist in identifying patients at high risk of having poor postoperative outcomes.…”

mentioning

confidence: 99%

Shoulder Arthroplasty Outcomes in Patients With Multiple Reported Drug Allergies

Rosenthal

Knesek

Kahlenberg

et al. 2016

Orthopaedic Journal of Sports Medicine

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Background:The presence of multiple allergies has been correlated with worse outcomes for patients undergoing hip and knee arthroplasty, but the effect of allergies has not yet been elucidated with respect to shoulder arthroplasty.Purpose/Hypothesis:The purpose of this study is to identify any discrepancies in shoulder arthroplasty outcomes with respect to reported drug allergies. We hypothesized that patients with multiple drug allergies would have inferior outcomes.Study Design:Cohort study; Level of evidence, 3.Methods:Included in the analysis were a single surgeon’s cases between 2009 and 2014 of primary total shoulder arthroplasty with a minimum of 180 days of follow-up. Cases with fracture as the indication were excluded. Preoperative and postoperative metrics included visual analog scale (VAS) for pain, forward flexion range of motion, and Simple Shoulder Test (SST) results, and postoperative patient satisfaction scores were also collected. Chi-square and 1-way analysis of variance with Tukey post hoc analyses were performed when appropriate.Results:A total of 98 patients were included (no allergies, n = 51; single allergy, n = 21; multiple allergies, n = 26). The proportion of females was greater with increasing number of allergies (no allergies, 31%; single allergies, 47%; multiple allergies, 88%; Pearson χ2 = 22.5; P < .0001). Both preoperatively and postoperatively, no difference was found between cohorts with respect to SST score, VAS score, or forward flexion. There was also no difference in postoperative satisfaction between cohorts. No difference between cohorts was identified when comparing the pre- to postoperative change in SST scores, VAS scores, or forward flexion.Conclusion:The presence of single or multiple allergies is not correlated with worse outcomes after primary anatomic total shoulder arthroplasty.

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“…Seventy articles were excluded after reviewing the title and abstract (some exclusion criteria: other joints than knee, allergic reaction to medication during surgery, infection, antibiotics, metallosis, and allergic reaction to suture material after surgery). Forty-six articles were included in the review: 17 case reports (Table 1), 4 reviews [5,15,42,43], 16 retrospective articles [11,17,19,26,32,33,35,41,45,46,48,51,52,54,61,63], 8 prospective articles [2,8,10,22,25,40,47,69], and one "expert opinion" [39].…”

Section: Methodsmentioning

confidence: 99%

“…A significant gender difference occurred (22% (19/86) female and 2% (1/53) male patients). Two studies [26,41] showed poor outcomes of TKA in patients with self-reported allergies. It is well known that patients' mental health is associated with poor outcomes after TKA.…”

Section: Patient Historymentioning

confidence: 99%

Allergy in Total Knee Replacement. Does It Exist?

2016

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Background: There is little data on whether preexisting allergies to implant materials and bone cement have an impact on the outcome of TKA. Questions/Purposes: This review article analyzes the current literature to evaluate the prevalence and importance of metal and cement allergies for patients undergoing total knee arthroplasty. Methods: A review of the literature was performed using the following search criteria: "knee," "arthroplasty," and "allergy" as well as "knee," "arthroplasty," and "hypersensitivity." Results: One hundred sixteen articles were identified on PubMed, Seventy articles could be excluded by reviewing the title and abstract leaving 46 articles to be included for this review. The majority of the studies cited patch testing as the gold standard for screening and diagnosis of hypersensitivity following TKA. There is consensus that patients with self-reported allergies against metals or bone cement and positive patch test should be treated with hypoallergenic materials or cementless TKA. Treatment options include the following: coated titanium or cobalt-chromium implants, ceramic, or zirconium oxide implants. Conclusion: Allergies against implant materials and bone cement are rare. Patch testing is recommended for patients with self-reported allergies. The use of special implants is recommended for patients with a confirmed allergy.

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Patient Reported Allergies Are a Risk Factor for Poor Outcomes in Total Hip and Knee Arthroplasty

Cited by 47 publications

References 12 publications

Hypersensitivity Reactions to Implanted Metal Devices: Facts and Fictions

Hypersensitivity Reactions to Implanted Metal Devices: Facts and Fictions

Shoulder Arthroplasty Outcomes in Patients With Multiple Reported Drug Allergies

Allergy in Total Knee Replacement. Does It Exist?

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