Vitiligo and Allergic Complications from Orthopaedic Joint Implants: The Role of Benzoyl Peroxide

Abstract

Orthopaedic joint implants and osteosynthetic materials are progressively being employed more often. Complications mainly include physical-mechanical problems and infections. Uncommonly, allergic reactions to an alloy metal or a bone cement component have been implicated. Less attention has been paid to the components of bone cement, such as acrylate, catalysers (e.g. peroxide), additive polymers or stabilisers. An important bone cement component is benzoylperoxide (BPO), an initiator of the process enhancement of the bone cement. Vitiligo is an acquired, progressive depigmenting disorder that can induce autoimmune diseases. The occurrence of vitiligo in combination with an infection or allergy is not well described, and this manuscript highlights the possibility of an occurrence of a vitiligo whenever the immunesystem is activated and T-cell activation is observed. The aim of this article was to analyze the diagnosis and management of vitiligo and allergic complications from orthopaedic joint implants due to benzoyl-peroxide and relevant patents.

A case series of cementless revision total knee arthroplasty in patients with benzoyl peroxide allergy

“…Further, there is some debate as to whether the metallic and acrylic abrasion, degradation, and reaction products from prosthesis components can actually be properly reproduced, as encountered in the periprosthetic tissues, in epicutaneous testing patches [2,15,25]. Similarly, the standardized allergen exposure time of 48-96 h in patch testing differs markedly from the far longer exposure time to implant materials and their abrasion or decay products, where weeks, months, or even years may pass before subsequent allergic reactions to orthopaedic implants are described [2,5,26]. Other concerns in regard to patch tests include the development of dermal immunological tolerance, as well as the possibility of subsequent allergy induction in potentially sensitive, but still asymptomatic patients [19].…”

Increased Risk of New-Onset Rheumatoid Arthritis Among Osteoarthritis Patients Received Total Knee Arthroplasty: a global federated health network analysis

“…Beyond metal implants, the utilization of intraoperative bone cements may also heighten the susceptibility to autoimmune diseases. Benzoyl Peroxide, a crucial constituent of bone cements, has been associated with conditions such as leukoplakia and allergic complications 31 . Moreover, individuals with autoimmune disorders exhibit an increased likelihood of experiencing allergic reactions to metal implants.…”

“…Notably, there have been instances of systemic lupus erythematosus in patients sensitized to molybdenum 30 . Moreover, the use of bone cement has been linked to depigmentation 31 .…”

Pilot study of contact sensitization to rubber allergens and bisphenol A amongst dental students

“…Benzoyl peroxide is an important bone cement component as well. Uncommonly, allergic reactions to orthopaedic joint implants due to benzoyl peroxide have been reported [19][20][21]. Benzoyl peroxide is also used as an initiator in dental applications [22].…”