Abstract
Total joint arthroplasties are increasingly common orthopedic procedures performed throughout the United States. Implant failure after these procedures occurs due to a number of causes such as infection or mechanical problems, with metal hypersensitivity being an area of growing interest. The nature and mechanism of a causative relationship between metal hypersensitivity and implant failure have been unclear as it is not known whether implant failure occurs due to a previous metal allergy or metal allergy results from secondary sensitization via metal exposure in existing failing implants. Overall, there appears to be growing support and evidence for metal-hypersensitive patients having worse outcomes with regard to total hip and knee arthroplasties. However, there are conflicting recommendations (outside of Nuss procedures) for pre-implant testing for metal hypersensitivity as testing has not consistently been shown to change patient outcomes.
Highlights
BackgroundIt has been estimated that over one million joint replacements are performed in the United States each year with joint replacement surgery accounting for the single largest category of Medicare expense [1]
While the subjects in this study did not undergo arthroplasty, this study suggests that lymphocyte transformation testing (LTT) is possibly a better test to screen cases of metal hypersensitivity
Outside of the Nuss bar procedures, there are currently no recommendations for mandated pre-implant testing for metal hypersensitivity for procedures including total joint arthroplasties
Summary
It has been estimated that over one million joint replacements are performed in the United States each year with joint replacement surgery accounting for the single largest category of Medicare expense [1]. With the exception of the Nuss bar procedure, there are no current recommendations for mandatory preimplant testing for metal hypersensitivity [14,16,17] This is due to the fact that pre-implant testing has not shown to consistently detect patients that may have a hypersensitivity reaction following joint replacement. Some studies and case reports have demonstrated that even in patients with patch test verified contact allergy to nickel, the implantation of a nickel-containing arthroplasty device has caused no significant complications on long -term follow up [41,42]. One case series showed that up to 5% of patients developed metal-related cutaneous complications post-implant, especially in those with chromium sensitivity [44] In another small study of 16 patients who required revision surgery due to pain, osteolysis, dislocation and/or loosening, 81 percent had metal sensitivity as determined by PT or LTT.
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
