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Prosthesis metal allergy

Fidel Peat, Ross Coomber, Adnan Rana, Alastair Vince
Allergic reactions to metals following joint arthroplasty represent a rare and poorly understood phenomenon. Much is still unknown regarding the natural history of this complication, and how it can best be prevented and managed. We present a case of a 68-year-old woman who underwent a left total knee arthroplasty for treatment of osteoarthritis. After an initial uneventful postoperative course, she developed a troublesome erythematous rash both around the incision site and over her trunk. Blood testing revealed no evidence of infection and clinically her prosthesis was functioning well...
January 18, 2018: BMJ Case Reports
Bernd Marx, Philip Kerschbaum, Stephanie Lindlahr, Rudolf Marx, Uwe Reisgen, Dieter Christian Wirtz
AIM: CoCrMo alloys are contraindicated for sufferers from allergy. For these patients, uncemented and cemented prostheses made of non-allergenic titanium alloy are indicated. Knee prostheses machined from that alloy, however, may have poor tribological behaviour, especially in contact to UHMWPE inlays. Therefore, high-strength oxide ceramics may be especially suitable for knee replacement in allergy patients with mobile bearing prostheses. For adhesion to bone cement, the ceramic surface only exhibits mechanical retention spots that are less adequate than those with a textured metal surface...
February 2018: Zeitschrift Für Orthopädie und Unfallchirurgie
Adrien Lons, Sophie Putman, Gilles Pasquier, Henri Migaud, Elodie Drumez, Julien Girard
INTRODUCTION: Metal-on-metal (MoM) hip replacement bearings produce metallic ions that can cause health complications. Metallic release also occurs with other materials, but data on metallic ion levels after knee arthroplasty are sparse. We postulate that knee replacement generates elevating metallic ions (chromium (Cr), cobalt (Co) and titanium (Ti)) during the first year after implantation. PATIENTS AND METHODS: This ongoing prospective study included all patients who underwent the same type of knee arthroplasty between May and December 2013...
December 2017: International Orthopaedics
Joseph Wawrzynski, Joseph A Gil, Avi D Goodman, Gregory R Waryasz
Awareness of rare etiologies for implant failure is becoming increasingly important. In addition to the overall increase in joint arthroplasties, revision surgeries are projected to increase dramatically in the coming years, with volume increasing up to seven-fold between 2005 and 2030. The literature regarding the relationship between metal allergy and implant failure is controversial. It has proven difficult to determine whether sensitization is a cause or a consequence of implant failure. Testing patients with functional implants is not a clinically useful approach, as the rate of hypersensitivity is higher in implant recipients than in the general population, regardless of the status of the implant...
June 2017: Rheumatology and Therapy
Ioannis P Stathopoulos, Nicolaos Andrianopoulos, Dimitrios Paschaloglou, Ioannis Tsarouchas
INTRODUCTION: Hypersensitivity to implants is a rare complication of total knee arthroplasty (TKA). Metal and, less frequently, bone cement can produce allergic symptomatology that if unresponsive to conservative treatment could lead to revision. MATERIALS AND METHODS: We present the case of a patient with generalized pruritus and metal taste starting during the first postoperative month after TKA. Dermal allergy exams revealed that the patient had hypersensitivity to nickel sulphate and cobalt chloride and bone cement...
February 2017: Archives of Orthopaedic and Trauma Surgery
Anna Maria Carossino, Christian Carulli, Simone Ciuffi, Roberto Carossino, Giorgia Donata Zappoli Thyrion, Roberto Zonefrati, Massimo Innocenti, Maria Luisa Brandi
BACKGROUND: All implant compounds undergo an electrochemical process when in contact with biological fluids, as well as mechanical corrosion due to abrasive wear, with production of metal debris that may inhibit repair processes. None of the commonly-used methods can diagnose implant allergies when used singly, therefore a panel of tests should be performed on allergic patients as pre-operative screening, or when a postoperative metal sensitisation is suspected. METHODS: We analysed patients with painful prostheses and subjects prone to allergies using the Patch Test in comparison with the Lymphocyte Transformation Test...
November 23, 2016: BMC Musculoskeletal Disorders
Xin Zhang, Li-Cheng Wei, Bin Wu, Li-Ying Yu, Xiao-Ping Wang, Yue Liu
The present study aimed to provide guidance for the selection of prosthodontic materials and the management of patients with a suspected metal allergy. This included a comparison of the sensitivity of patients to alloys used in prescribed metal‑containing prostheses, and correlation analysis between metal allergy and accompanying clinical symptoms of sensitized patients using a patch test. The results from the patch test and metal component analyses were processed to reach a final diagnosis. In the present study, four dental alloys were assessed...
January 2016: Molecular Medicine Reports
Maria Claudia Lucchetti, Giovanni Fratto, Federica Valeriani, Elisabetta De Vittori, Saverio Giampaoli, Patrizia Papetti, Vincenzo Romano Spica, Licia Manzon
STATEMENT OF PROBLEM: Metal ions released into the oral cavity from dental prosthesis alloys may damage the cellular metabolism or proliferation and cause hypersensitivity or allergies. The oral cavity environment is particularly prone to corrosion due to saliva, microorganisms, and pH variations. PURPOSE: The purpose of this in vitro study was to evaluate the ion release of chromium, cobalt, and iron from the Co-Cr alloys used for traditionally cast and computer-aided design/computer-aided manufacturing dental devices after interaction with oral bacteria and different pH conditions...
October 2015: Journal of Prosthetic Dentistry
B Marx, R Marx, U Reisgen, D Wirtz
AIM: CoCrMo alloys are contraindicated for allergy sufferers. For these patients, uncemented and cemented prostheses made of titanium alloy are indicated. Knee prostheses machined from that alloy, however, may have poor tribological behaviour, especially in relation to UHMWPE inlays. Therefore, for knee replacement cemented high-strength oxide ceramic prostheses are suitable for allergy sufferers and in cases of particle-induced aseptic loosening. For adhesion of bone cement, the ceramic surface, however, only exposes inefficient mechanical retention spots as compared with a textured metal surface...
April 2015: Zeitschrift Für Orthopädie und Unfallchirurgie
Md Quamar Azam, Stephen McMahon, Gabrielle Hawdon, Sukesh Rao Sankineani
INTRODUCTION: Resurfacing as a percentage of total hip arthroplasty rose from 5.6 % in 2001 to 8.9 % in 2005 in Australia. During the same period the resurfacing to conventional prosthesis rose from 19.6 % to 29 % in the younger age group (less than 55 years). Long term (more than ten years) functional results of BHR are sparingly documented. Among the literatures available, the patient selection criteria vary from osteoarthritis, avascular necrosis, and dysplastic hip to slipped capital femoral epiphysis...
January 2016: International Orthopaedics
Peter Thomas, Burkhard Summer
Cutaneous allergic reactions to implanted metal devices, for example, orthopedic, are well reported in the literature. Also, extracutaneous complications resulting from peri-implant inflammation have been observed in association with metal allergy. Nickel, cobalt, and chromium are the three most common triggers of both cutaneous and extracutaneous allergy-related complications. However, the diagnosis of metal implant allergy remains a challenge, that is, the synopsis of excluding differential diagnoses and the combination of different allergy diagnostic tools is needed...
April 2015: Expert Review of Clinical Immunology
Henrik J Münch, Stig S Jacobsen, Jens T Olesen, Torkil Menné, Kjeld Søballe, Jeanne D Johansen, Jacob P Thyssen
BACKGROUND AND PURPOSE: It is unclear whether delayed-type hypersensitivity reactions against implanted metals play a role in the etiopathogenesis of malfunctioning total knee arthroplasties. We therefore evaluated the association between metal allergy, defined as a positive patch test reaction to common metal allergens, and revision surgery in patients who underwent knee arthroplasty. PATIENTS AND METHODS: The nationwide Danish Knee Arthroplasty Register, including all knee-implanted patients and revisions in Denmark after 1997 (n = 46,407), was crosslinked with a contact allergy patch test database from the greater Copenhagen area (n = 27,020)...
June 2015: Acta Orthopaedica
L Morawietz, V Krenn
Approximately 230,000 total hip and 170,000 knee joint endoprostheses are implanted in Germany annually of which approximately 10% (i.e. 40,000 interventions per year) are cases of revision surgery. These interventions involve removal of a previously implanted prosthesis which has resulted in complaints and replacement with a new prosthesis. There are manifold reasons for revision surgery, the most common indication being so-called endoprosthesis loosening, which is subdivided into septic and aseptic loosening...
November 2014: Der Pathologe
Kazuhiro Sakamoto, Kohei Ando, Daisuke Noma
The Nuss procedure requires the placement of metal bars in the chest cage to repair pectus excavatum. Metal allergies are one of the complications associated with this procedure. Given that titanium is a biocompatible metal, it induces few allergic symptoms. Therefore, titanium bars are recommended for patients with metal sensitivity. We report the case of a 17-year-old boy with pectus excavatum who had a metal allergy to titanium bars, which occurred after the Nuss procedure. The administration of oral steroids is useful for treating metal allergies...
August 2014: Annals of Thoracic Surgery
Luigi Tarallo, Raffaele Mugnai, Roberto Adani, Francesco Zambianchi, Fabio Catani
BACKGROUND: Implants based on the polyetheretherketon (PEEK) polymer have been developed in the last decade as an alternative to conventional metallic devices. PEEK devices may provide several advantages over the use of conventional orthopedic materials, including the lack of metal allergies, radiolucency, low artifacts on magnetic resonance imaging scans and the possibility of tailoring mechanical properties. The purpose of this study was to evaluate the clinical results at 12-month follow-up using a new plate made of carbon-fiber-reinforced polyetheretherketon for the treatment of distal radius fractures...
December 2014: Journal of Orthopaedics and Traumatology: Official Journal of the Italian Society of Orthopaedics and Traumatology
Adam D Bloemke, Henry D Clarke
No validated screening method exists to identify patients at risk for metal allergy complications following total knee arthroplasty (TKA). Select use of implants that do not contain nickel, cobalt, and chromium may be considered in patients at risk. This study was performed to determine the rate of self-reported cutaneous metal allergy, or sensitivity, in patients undergoing knee replacement, and to evaluate whether there is a higher prevalence in females. A retrospective chart review was performed on 194 consecutive patients who underwent primary knee arthroplasty with a single surgeon between 2010 and 2011...
June 2015: Journal of Knee Surgery
Marco S Caicedo, Edward Solver, Latasha Coleman, Nadim James Hallab
Metal sensitivity testing is generally the diagnosis method of last resort for aseptic painful implants with elevated inflammatory responses. However, the relationship between implant-related pain and implant-debris-related metal sensitization remains incompletely understood. Although a sensitivity to nickel alone has been used as a general measure of metal allergy, it may lack the specificity to correlate sensitivity to specific implant metals and thus to select a biologically appropriate implant material...
2014: Journal of Long-term Effects of Medical Implants
Michael Amini, Wesley H Mayes, Alice Tzeng, Tony H Tzeng, Khaled J Saleh, William M Mihalko
Metal hypersensitivity has been an identified problem in orthopedics for nearly half a century, but its implications remain unclear. Establishing which total joint arthroplasty (TJA) candidates may do poorly with conventional implants and which patients would benefit from revision to an allergen-free implant remains challenging. Our systematic search of the MEDLINE database identified 52 articles for inclusion in our review. Case reports revealed that half of patients presented with pain and swelling, while only one-third presented with cutaneous symptoms...
2014: Journal of Long-term Effects of Medical Implants
Yue Liu, Xiao-ping Wang, Bin Wu, Yue Hu, Xia Dou, Hong-ying Sun, Ya-tong Ding, Xin Zhang
PURPOSE: To compare the sensitivity of different dental metal materials, in order to provide references for choosing of dental metal materials. METHODS: Patch test was performed on 92 patients wearing dental metal prosthesis. Pearson Chi-square test, corrected Chi-square test and Fisher exact test were used for statistical analysis with SPSS17.0 software package. RESULTS: (1)The sensitivity rates of different metal materials were different...
April 2014: Shanghai Kou Qiang Yi Xue, Shanghai Journal of Stomatology
Klas Gustafson, Stig S Jakobsen, Nina D Lorenzen, Jacob P Thyssen, Jeanne D Johansen, Charlotte M Bonefeld, Maiken Stilling, Thomas Baad-Hansen, Kjeld Søballe
BACKGROUND: Metal-on-metal (MOM) total hip arthroplasties were reintroduced because of the problems with osteolysis and aseptic loosening related to polyethylene wear of early metal-on-polyethylene (MOP) arthroplasties. The volumetric wear rate has been greatly reduced with MOM arthroplasties; however, because of nano-size wear particles, the absolute number has been greatly increased. Thus, a source of metal ion exposure with the potential to sensitize patients is present. We hypothesized that higher amounts of wear particles result in increased release of metal ions and ultimately lead to an increased incidence of metal allergy...
August 2014: Acta Orthopaedica
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