The effect of patient-reported metal allergies on the outcomes of shoulder arthroplasty

Kennon, Justin C.; Lee, Jung Hwa; Songy, Chad E.; Shukla, Dave R.; Cofield, Robert H.; Sánchez-Sotelo, Joaquín; Sperling, John W.

doi:10.1016/j.jse.2019.06.006

Cited by 13 publications

(15 citation statements)

References 23 publications

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“…Increased accidental bone injuries and osteoporosis-induced fractures demand biomaterial-based cell-free approaches for treating bone defects . Traditional approaches like allograft, autograft, or biological filler materials have disadvantages like high cost involved, , immune response, , etc. While mesenchymal stromal cells (MSCs) have been shown to have regenerative properties in bone regeneration, their unpredictable growth and differentiation capacity in vivo , − their reduced transportation competence through blood vessels, − raising ethical concerns, and the need for stringent storage and maintenance conditions − make them less suitable for cell therapy.…”

Section: Introductionmentioning

confidence: 99%

Hydrogel-Assisted 3D Model to Investigate the Osteoinductive Potential of MC3T3-Derived Extracellular Vesicles

Holkar

Kale

Ingavle

2021

ACS Biomater. Sci. Eng.

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Effective and rapid regeneration of bone defects often pose substantial challenges in severe accidental injuries and disabilities occurring due to diseases and/or advanced age, especially in patients having reduced tissue regeneration competence. The success of mesenchymal stromal cell (MSC)-based research strategies in improving bone regeneration was hampered not only due to the limited knowledge of therapeutic actions of MSCs but also due to difficulties as well as expenses related to cell manufacturing and time taken for ethical approvals for clinical use of living cells and engineered tissues. The recent trend indicated that there is a shift from the direct usage of MSCs toward the application of paracrine factors and extracellular vesicles (EVs) isolated from their MSC secretome in bone tissue regeneration. This shift has directed research into the development of "cell-free" therapeutics, which could be a better alternative due to its several advantages over the use of their parental MSCs. Furthermore, accumulating evidence suggested that the 3D microenvironment influences the paracrine effects of MSCs. Although the osteogenic role of EVs has been explored recently, the current study showed, for the first time, that encapsulation of EVs along with MC3T3 cells in a 3D hydrogel-assisted culture with a distinct porous microenvironment having meso and macro (0.05−200 μm) pore size distribution resulted in an improved osteogenic response in vitro. The present work was primarily focused on investigating the influence of EVs isolated under distinct priming conditions to enhance the osteogenic potential. In addition, in the current work, the osteogenic ability of different types of EVs (microvesicles and exosomes) and total EVs isolated at different time points was also examined when encapsulated with MC3T3 cells in an alginate gel. Using various biochemical assays, such as alkaline phosphatase (ALP) production and calcium secretion, it was observed that both microvesicles and exosomes collected from MC3T3 cells independently had osteogenic potential; however, their collective activity was found to be superior. We further showed that EVs induce an early osteogenic response in MC3T3 cells as indicated by ALP and calcium secretion at a much earlier time point, compared to the controls. Our data suggested that this 3D hydrogel-assisted system provides close proximity of cells and EVs, and thus, mimics the in vivo scenario, making it clinically useful for bone tissue engineering.

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Section: Introductionmentioning

confidence: 99%

Hydrogel-Assisted 3D Model to Investigate the Osteoinductive Potential of MC3T3-Derived Extracellular Vesicles

Holkar

Kale

Ingavle

2021

ACS Biomater. Sci. Eng.

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“…and Rosenthal et al. reported no differences in functional outcomes among shoulder arthroplasty patients with self-reported metal allergies or increasing PRAs in cohorts of 52 and 98 arthroplasties, respectively [ 9 , 23 ]. However, a retrospective review of 415 shoulder arthroplasties by Menendez et al.…”

Section: Discussionmentioning

confidence: 99%

Increasing patient-reported allergies are not associated with pain, functional outcomes, or satisfaction following medial patellofemoral ligament reconstruction: a retrospective comparative cohort study

Shankar

Vasavada

et al. 2022

Knee Surg & Relat Res

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Background Patient-reported allergies (PRAs) are often stigmatized as a potential nonmodifiable risk factor for increased pain and worse functional outcomes following surgery. However, there is a dearth of literature directly assessing the impact of PRAs on outcomes in sport surgeries such as medial patellofemoral ligament reconstruction (MPFLR). The purpose of our study was to determine whether PRAs were associated with worse outcomes following MPFLR. Methods We conducted a retrospective review of patients who underwent MPFLR at our institution from 2011 to 2019. Patients were included if they had at least 12 months of follow-up. PRAs were obtained from preoperative medical assessments and categorized by drug class. Demographic and perioperative data were obtained from electronic medical records. Postoperative outcomes were measured using a telephone survey and included recurrent instability, Visual analog scale (VAS) for pain, VAS for sports, Kujala score, MPFL-Return to Sport after Injury (MPFL-RSI) score, and overall satisfaction score. Multiple linear regression was used to determine association between PRAs and outcome measures, and p-values less than 0.05 were considered significant. Results The cohort included 141 MPFLR. Most patients were female (98, 70%) with an average age of 25 years (range 12–56 years). Average follow-up time was 47 months. Forty-seven patients (33%) reported at least one PRA. There were no significant differences in postoperative pain, functional outcomes, satisfaction, or return to sport between patients with or without PRAs (all p > 0.05). Absence of antibiotic PRAs was predictive of higher VAS (p < 0.007), but there were no other differences. There were no significant differences in outcomes between patients without PRAs, PRAs without a concomitant psychiatric disorder, or PRAs with a concomitant psychiatric disorder (all p > 0.05). Conclusions In conclusion, PRAs with or without concomitant psychiatric diagnoses are not associated with worse postoperative pain, functional outcomes, or satisfaction following MPFLR with allograft, dispelling common misconceptions that increased number of allergies or psychiatric diagnoses lead to inferior surgical outcomes. Presence of antibiotic allergies was associated with lower VAS postoperative pain score. Future research should investigate the relationship between PRAs and other surgeries in the field of sports medicine.

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“…Hypersensitivity following shoulder arthroplasty is an underexplored subject in the literature. Only a few studies have focused on the possible allergic reactions to metals in patients who underwent shoulder replacement [32,33]. Ko et al [32] identified 6 patients with metal allergy after shoulder arthroplasty in a population of 1243 patients.…”

Section: Discussionmentioning

confidence: 99%

“…All the patients but the latter one (no hypoallergenic implant was available for him) underwent revision surgery and 4 reported improvement in symptoms. Kennon et al [33] have recently retrospectively reported on 43 patients, with a total of 52 having undergone shoulder arthroplasty, who self-reported metal hypersensitivity.…”

Section: Discussionmentioning

confidence: 99%

Allergic reaction and metal hypersensitivity after shoulder joint replacement

et al. 2021

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Purpose Metal ion release may cause local and systemic effects and induce hypersensitivity reactions. The aim of our study is first to determine if implant-related hypersensitivity correlates to patient symptoms or not; second, to assess the rate of hypersensitivity and allergies in shoulder arthroplasty. Methods Forty patients with shoulder replacements performed between 2015 and 2017 were studied with minimum 2-year follow-up; no patient had prior metal implants. Each patient underwent radiographic and clinical evaluation using the Constant-Murley Score (CMS), 22 metal and cement haptens patch testing, serum and urine tests to evaluate 12 metals concentration, and a personal occupational medicine interview. Results At follow-up (average 45 ± 10.7 months), the mean CMS was 76 ± 15.9; no clinical complications or radiographic signs of loosening were detected; two nickel sulfate (5%), 1 benzoyl peroxide (2.5%) and 1 potassium dichromate (2.5%) positive findings were found, but all these patients were asymptomatic. There was an increase in serum aluminum, urinary aluminum and urinary chromium levels of 1.74, 3.40 and 1.83 times the baseline, respectively. No significant difference in metal ion concentrations were found when patients were stratified according to gender, date of surgery, type of surgery, and type of implant. Conclusions Shoulder arthroplasty is a source of metal ion release and might act as a sensitizing exposure. However, patch test positivity does not seem to correlate to hypersensitivity cutaneous manifestations or poor clinical results. Laboratory data showed small constant ion release over time, regardless of gender, type of shoulder replacement and implant used. Levels of evidence Level II.

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The effect of patient-reported metal allergies on the outcomes of shoulder arthroplasty

Cited by 13 publications

References 23 publications

Hydrogel-Assisted 3D Model to Investigate the Osteoinductive Potential of MC3T3-Derived Extracellular Vesicles

Hydrogel-Assisted 3D Model to Investigate the Osteoinductive Potential of MC3T3-Derived Extracellular Vesicles

Increasing patient-reported allergies are not associated with pain, functional outcomes, or satisfaction following medial patellofemoral ligament reconstruction: a retrospective comparative cohort study

Allergic reaction and metal hypersensitivity after shoulder joint replacement

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