Metal Hypersensitivity in Patients with Conventional Orthopaedic Implants.

Abstract

Metal implants are widely used in orthopaedic surgery for elective joint arthroplasty or fracture fixation. Metal alloys also are widely used in other medical specialties for devices such as dental implants, cardiovascular stents, and gastrointestinal wire mesh stents. Metal hypersensitivity, as detected with skin patch testing, is common, with a prevalence of between 10% to 17% in the general population1-5. This raises the concern that hypersensitivity reactions may occur in patients with metallic orthopaedic implants and the possibility that metal hypersensitivity reactions may account for ongoing pain or aseptic loosening following joint arthroplasty6,7. The purpose of the present review is to examine the current understanding of metal hypersensitivity and its potential clinical importance in orthopaedic surgery. The methods of testing for metal hypersensitivity and the limitations of such tests are also discussed. In this article, we consider conventional arthroplasty implants (metal-polyethylene and metal-ceramic articulations) and fracture-fixation devices. Coverage of the localized reactions reported in association with metal-on-metal arthroplasty is beyond …