1
|
Taliercio MJ, Alnabulsi RK, Uppal PA, Shaw IM, Semenza KM, Pasha MA. Metal implant allergy: A retrospective cohort analysis at a university allergy practice. Allergy Asthma Proc 2024; 45:186-194. [PMID: 38755777 DOI: 10.2500/aap.2024.45.240005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/18/2024]
Abstract
Background: Concern of metal sensitization in pre- and postsurgical evaluation is growing, with the recent guidelines remaining the criterion standard for consideration of patch testing. Information remains scarce on surgical screening in the groups of patients who reported a history of metal sensitivity versus those with no reported history. Objective: The objective of this study was to assess the utility of patch testing in surgical candidates based on reported metal allergy history. The secondary objective was to evaluate the utility and outcomes in postsurgical patch testing. Methods: Nine hundred and thirty-one patient charts of patients with the diagnosis of "contact dermatitis" who underwent an evaluation at a single allergy clinic site between January 2013 and December 2022 were identified and reviewed as part of a retrospective chart review study. Patients were included in subgroups based on the time of patch testing and history of reported metal allergy. Results: In all, 67 patients underwent patch testing, 10 (14.9%) of whom were surgical candidates without a history of metal sensitivity, 31 (46.2%) of whom were surgical candidates with a history of metal sensitivity, and 26 (38.8%) of whom were postsurgical patients. Twenty-nine (43.3%) of patients had positive patch testing results, with only one (10%) in the presurgical group, 17 (54.8%) in the presurgical with a history of metal sensitivity, and 11 (42.3%) in the postsurgical group. Zero patients in our cohort without metal sensitivity who were undergoing the Nuss procedure had positive reactions on patch testing, whereas two of four (50%) with reported metal sensitivity who were undergoing the Nuss procedure had positive relevant metal reactions. Conclusion: Ambiguity in the utility of patch testing for surgical decision making remains, despite common utilization. Recent guidelines along with coordination of care among the surgeon, allergist, and patient remains the criterion standard of care.
Collapse
Affiliation(s)
- Mark J Taliercio
- From the Department of Internal Medicine, Albany Medical Center, Albany, New York
| | - Rawaa K Alnabulsi
- Division of Allergy and Immunology, Department of Internal Medicine, Albany Medical Center, Albany, New York
| | | | - Ian M Shaw
- Department of Pediatrics, Albany Medical Collage, Albany, New York, and
| | - Kristy M Semenza
- Department of Allergy and Immunology, Bassett Medical Center, Cooperstown, New York
| | - Muhammad A Pasha
- Division of Allergy and Immunology, Department of Internal Medicine, Albany Medical Center, Albany, New York
| |
Collapse
|
2
|
Chen A, Kurmis AP. Understanding immune-mediated cobalt/chromium allergy to orthopaedic implants: a meta-synthetic review. ARTHROPLASTY 2024; 6:1. [PMID: 38303027 PMCID: PMC10835847 DOI: 10.1186/s42836-023-00227-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/29/2023] [Accepted: 12/12/2023] [Indexed: 02/03/2024] Open
Abstract
BACKGROUND The frequency of primary joint replacement surgery continues to increase worldwide. While largely considered biologically inert entities, an increasing body of evidence continues to validate a not insignificant incidence of allergic reactions to such implants. Little previous work has explored genuinely immune-mediated reactivity in this context. In the absence of a contemporary published summary on the topic, this paper explored the current state of understanding of cobalt/chromium allergy and proposes a patient management algorithm whereby such immune reactions are clinically suggested. METHODS A structured, systematic literature review was performed by following PRISMA search principles to provide an updated review of this area. RESULTS Thirty-six topic-related articles were identified, the majority reflecting lower tiers of scientific evidence with a lack of homogeneous quantitative data to facilitate valid cohort comparisons. Largely, the available literature represented small case series' or expert opinions. CONCLUSIONS Despite increasing clinical awareness and acknowledgement of true allergy to joint replacement components, this review highlighted that the evidence base underpinning the diagnosis and management of such patients is limited. Both patient-reported metal allergy or skin patch testing are grossly unreliable methods and show almost no correlation with true immune reactivity. Recent studies suggested a potential role for patient-specific in vitro cellular activation testing and/or targeted genetic testing when cobalt/chromium allergy is clinically suspected. However, while likely representing the contemporary "best available" approaches both can be costly undertakings, are not yet universally available, and still require broader validation in non-research settings before wider uptake can be championed.
Collapse
Affiliation(s)
- Arnold Chen
- School of Medicine, University of Adelaide, Adelaide, SA, 5000, Australia
| | - Andrew P Kurmis
- Discipline of Medical Specialties, University of Adelaide, Adelaide, SA, 5000, Australia.
- Department of Orthopaedic Surgery, Lyell McEwin Hospital, Elizabeth Vale, SA, 5112, Australia.
- College of Medicine & Public Health, Flinders University, Bedford Park, SA, 5042, Australia.
| |
Collapse
|
3
|
Kennon JC, Lee J, Songy C, Shukla D, Cofield RH, Sanchez-Sotelo J, Sperling JW. The effect of patient-reported metal allergies on the outcomes of shoulder arthroplasty. J Shoulder Elbow Surg 2020; 29:296-301. [PMID: 31427231 DOI: 10.1016/j.jse.2019.06.006] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2019] [Revised: 05/29/2019] [Accepted: 06/07/2019] [Indexed: 02/01/2023]
Abstract
BACKGROUND Although literature exists regarding hip and knee arthroplasty outcomes in patients with skin allergy to metals, there is minimal information about skin allergy implications on shoulder arthroplasty outcomes. The purpose of this study was to determine the results, complications, and failure rate among patients with a self-reported metal allergy undergoing shoulder arthroplasty. METHODS Fifty-two shoulder arthroplasties were performed at our Institution in 43 patients with self-reported metal allergies. Forty primary and 12 revision shoulder arthroplasties were performed using anatomic (30) and reverse (22) components. Retrospective chart review was performed to determine metal allergy history, implant composition, pain, motion, and complications. Radiographs were reviewed to determine mechanical failure rates. Average follow-up time was 65 months. RESULTS Allergies reported included nickel (37), cobalt chrome (4), copper (2), zinc (1), titanium (1), gold (1), and nonspecific metal allergy (8); 8 patients reported multiple metal allergies. All components implanted in patients with nickel allergies contained nickel. At most recent follow-up, pain was rated as none or mild in 88% of shoulders. Active elevation improved from 80° to 141° and external rotation from 24° to 52°. Two revisions were performed for glenoid loosening (3.8%); both were revision cases with substantial glenoid bone loss. One patient with mild pain had a radiographically loose glenoid component 12 years after anatomic shoulder arthroplasty. CONCLUSION Results from this study suggest that shoulder arthroplasty in patients with self-reported metal allergy provides satisfactory pain relief and improved range of motion with low revision rates.
Collapse
Affiliation(s)
- Justin C Kennon
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Julia Lee
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Chad Songy
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Dave Shukla
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | - Robert H Cofield
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - John W Sperling
- Department of Orthopedic Surgery, Mayo Clinic, Rochester, MN, USA.
| |
Collapse
|
4
|
Abstract
Osteosynthesis materials or artificial joint replacement make part of clinical routine. In case of complaints mostly mechanical causes or infections are found. Metals like nickel, chromium and cobalt or bone cement components like acrylates and gentamicine may however potentially cause intolerance reactions to implants. Correspondingly, eczema, delayed wound/bone healing, recurrent effusion, pain or implant loosening have been described as manifestation of implant allergy. In contrast to the high incidence of cutaneous metal allergy, allergies associated with implants are rare. Diagnosis of metal implant allergy is based on excluding differential diagnoses – in particular infection – and on a combined approach of allergological diagnostics by patch test and histopathology of periimplant tissue. Risk factors for allergic sensitization to implants or triggering periimplant allergic reactions in the case of preexisting cutaneous metal allergy are unknown. Despite the risk of developing complications being unclear, titanium-based osteosynthesis materials are recommended for metal-allergic patients and the use of metal-metal couplings in arthroplasty is rather not recommended for such patients. If a regular, potentially applicable CoCr-polyethylene articulation is preferred, the patient has to be well informed and has to give his written consent.
Collapse
|
5
|
Abstract
BACKGROUND There is little data on whether preexisting allergies to implant materials and bone cement have an impact on the outcome of TKA. QUESTIONS/PURPOSES This review article analyzes the current literature to evaluate the prevalence and importance of metal and cement allergies for patients undergoing total knee arthroplasty. METHODS A review of the literature was performed using the following search criteria: "knee," "arthroplasty," and "allergy" as well as "knee," "arthroplasty," and "hypersensitivity." RESULTS One hundred sixteen articles were identified on PubMed, Seventy articles could be excluded by reviewing the title and abstract leaving 46 articles to be included for this review. The majority of the studies cited patch testing as the gold standard for screening and diagnosis of hypersensitivity following TKA. There is consensus that patients with self-reported allergies against metals or bone cement and positive patch test should be treated with hypoallergenic materials or cementless TKA. Treatment options include the following: coated titanium or cobalt-chromium implants, ceramic, or zirconium oxide implants. CONCLUSION Allergies against implant materials and bone cement are rare. Patch testing is recommended for patients with self-reported allergies. The use of special implants is recommended for patients with a confirmed allergy.
Collapse
|
6
|
|
7
|
Cottino U, Rosso F, Pastrone A, Dettoni F, Rossi R, Bruzzone M. Painful knee arthroplasty: current practice. Curr Rev Musculoskelet Med 2015; 8:398-406. [PMID: 26400422 DOI: 10.1007/s12178-015-9296-5] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
Primary total knee arthroplasty is the treatment for end-stage arthritis of the knee; in the last years, it is becoming more common and reliable, due to technical and implant improvement. With larger implant rates, the overall complications will increase and pain is the most common sign of implant failure. Pain can be related to a lot of different clinical findings, and the surgeon has to be aware of the various etiologies that can lead to failure. Pain does not always mean revision, and the patient has to be fully evaluated to have a correct diagnosis; if surgery is performed for the wrong reason, this will surely lead to a failure. In this paper, the authors revised the more common causes of failure that can have a painful onset proposing an approach for diagnosis and treatment.
Collapse
Affiliation(s)
- Umberto Cottino
- Department of Orthopedic Surgery, Osp. Mauriziano, Largo Turati, 62, 10100, Torino, Italy.
| | - Federica Rosso
- Department of Orthopedic Surgery, Osp. Mauriziano, Largo Turati, 62, 10100, Torino, Italy.
| | - Antonio Pastrone
- Department of Orthopedic Surgery, Osp. Mauriziano, Largo Turati, 62, 10100, Torino, Italy.
| | - Federico Dettoni
- Department of Orthopedic Surgery, Osp. Mauriziano, Largo Turati, 62, 10100, Torino, Italy.
| | - Roberto Rossi
- Department of Orthopedic Surgery, Osp. Mauriziano, Largo Turati, 62, 10100, Torino, Italy.
| | - Matteo Bruzzone
- Department of Orthopedic Surgery, Osp. Mauriziano, Largo Turati, 62, 10100, Torino, Italy.
| |
Collapse
|
8
|
Stiehler M, Zobel F, Hannemann F, Schmitt J, Lützner J, Kirschner S, Günther KP, Hartmann A. [Complications of metal-on-metal tribological pairing]. DER ORTHOPADE 2014; 43:79-91. [PMID: 24356820 DOI: 10.1007/s00132-013-2131-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Metal-on-metal (MoM) tribological pairing results in less volumetric abrasion than pairing with the conventionally used polyethylene and is associated with a lower risk of material failure compared to other hard-hard pairings. An increased frequency of problem cases in recent years has led to a great increase in uncertainty. Against this background in this article the current aspects of epidemiology, etiology, diagnostics and treatment of complications in MoM hip joint endoprostheses will be discussed. EPIDEMIOLOGY AND ETIOLOGY Based on the results from national endoprosthesis registers and selected clinical studies an evaluation of the rate of local complications from MoM tribological pairings was undertaken. A differentiation was made between MoM pairings in pedicled small head prostheses (≤ 32 mm), large head (> 32 mm) and surface replacement (OFE) endoprostheses. Each year MoM endoprostheses release on average 10(12)-10(14) cobalt (Co) and chromium (Cr) nanoparticles per patient. This release of metal ions and particles can lead to a variety of tissue reactions. DIAGNOSTICS A differentiation must be made between regular routine diagnostics within the framework of implant follow-up screening and specific investigations due to the occurrence of complaints. The diagnostics for patients treated with MoM hip endoprostheses consists of a standardized step-wise approach considering possible differential diagnoses and the utilization of modern laboratory chemical and radiological methods. When problems occur, a differentiation should preferentially be made between complaints not caused by metal and mechanical problems (e.g. prosthesis loosening and impingement) and symptoms due to periprosthetic infections. THERAPY OF COMPLICATIONS The normal standards for hip endoprosthetics are also valid for periprosthetic infections, fractures and other general complications. Specific measures are, however, necessary for complications due to metal-specific risks.
Collapse
Affiliation(s)
- M Stiehler
- UniversitätsCentrum für Orthopädie und Unfallchirurgie, Klinik für Orthopädie, Universitätsklinikum Carl Gustav Carus, TU Dresden, Fetscherstr. 74, 01307, Dresden, Deutschland
| | | | | | | | | | | | | | | |
Collapse
|
9
|
Abstract
In a representative survey among members of the working group for joint replacement (AE) in Germany (86.7% response) it was found that 0.6% of patients with total knee arthroplasty (TKA) and 1.2% of patients with total hip arthroplasty (THA) may have a problem due to hypersensitivity to nickel or cobalt after implantation. Only one third of them may need revision surgery. Although patients with hypersensitivity are rare 84% of surgeons would prefer to use a specially coated allergy implant for knee arthroplasty patients. However, no long term results and few data on the topic of allergies and joint arthroplasty are available for these implants so that this has to be critically discussed with patients. Before a revision is performed it is recommended to perform knee arthroscopy to obtain tissue for microbiological and histopathological investigations. The second part of this questionnaire will look at the special question of how to deal with allergy patients based on constructed case examples.
Collapse
|
10
|
Kretzer JP, Reinders J, Sonntag R, Hagmann S, Streit M, Jeager S, Moradi B. Wear in total knee arthroplasty--just a question of polyethylene?: Metal ion release in total knee arthroplasty. INTERNATIONAL ORTHOPAEDICS 2013; 38:335-40. [PMID: 24218115 DOI: 10.1007/s00264-013-2162-4] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/09/2013] [Accepted: 10/20/2013] [Indexed: 11/25/2022]
Abstract
PURPOSE Biological reactions against wear particles are a common cause for revision in total knee arthroplasty. To date, wear has mainly been attributed to polyethylene. However, the implants have large metallic surfaces that also could potentially lead to metal wear products (metal ions and debris). The aim of this study was to determine the local release of cobalt, chromium, molybdenum and titanium in total knee arthroplasty during a standard knee wear test. METHODS Four moderately conforming fixed-bearing implants were subjected to physiological loadings and motions for 5×10(6) walking cycles in a knee wear simulator. Polyethylene wear was determined gravimetrically and the release of metallic wear products was measured using high resolution-inductively coupled plasma-mass spectrometry. RESULTS A polyethylene wear rate of 7.28 ± 0.27 mg/10(6) cycles was determined and the cumulative mass of released metals measured 1.63 ± 0.28 mg for cobalt, 0.47 ± 0.06 mg for chromium, 0.42 ± 0.06 mg for molybdenum and 1.28 ± 0.14 mg for titanium. CONCLUSION For other metallic implants such as metal-on-metal total hip arthroplasty, the metal wear products can interact with the immune system, potentially leading to immunotoxic effects. In this study about 12 % by weight of the wear products were metallic, and these particles and ions may become clinically relevant for patients sensitive to these materials in particular. Non-metallic materials (e.g. ceramics or suitable coatings) may be considered for an alternative treatment for those patients.
Collapse
Affiliation(s)
- Jan Philippe Kretzer
- Laboratory of Biomechanics and Implant Research, Department of Orthopaedics & Trauma Surgery, Heidelberg University Hospital, Heidelberg, Germany,
| | | | | | | | | | | | | |
Collapse
|
11
|
Abdul N, Fountain J, Stockley I. Infection versus ALVAL: acute presentation with abdominal pain. BMJ Case Rep 2013; 2013:bcr-2013-009976. [PMID: 23761510 DOI: 10.1136/bcr-2013-009976] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
A 52-year-old man underwent bilateral articular surface replacement (ASR) DePuy in June 2006. Following a right femoral neck fracture 4 days postoperatively, he underwent revision to a cemented C-stem DePuy, a taper sleeve adaptor and a 47 mm diameter cobalt chromium femoral head. The patient recovered well with satisfactory 5-year follow-up. In September 2011 the patient presented to the accident and emergency department with a 5-day history of feeling unwell with right lower quadrant pain. Examination of the right hip was unremarkable apart from painful adduction. Blood tests showed raised inflammatory markers and white cell count. MRI scan showed a right iliopsoas collection which appeared to communicate with the hip joint. The patient underwent a direct exchange of the right hip prosthesis. The intraoperative clinical picture was suggestive of atypical lymphocytic vasculitis and associated lesions. The patient recovered well and was discharged home. At his last clinic visit he was well and pain free.
Collapse
Affiliation(s)
- Nicole Abdul
- Department of Orthopaedic Surgery, Northern General Hospital, Sheffield, UK.
| | | | | |
Collapse
|
12
|
Abstract
Hypersensitivity reactions to nickel are one of the most common in the modern world. Nickel allergy prevalence is constantly growing in many countries and represents a major health and socioeconomic issue. Herein the current understanding on nickel allergy is summarized with a practical approach to the dermatologist, allergist, and general practitioner. The personal experience with some practical clinical cases of nickel dermatitis is shared. A special emphasis is put on the possible strategies for treatment and prevention of the disease.
Collapse
|
13
|
Abstract
Systemic contact dermatitis is an inflammatory skin disease that may occur in persons with contact allergy when they are exposed to the hapten orally, transcutaneously, per rectum, intravesically, intravenously, or by inhalation. The most common causes of systemic contact dermatitis are drugs used both topically and systemically. Other causes are ubiquitously occurring haptens, such as the metals nickel, cobalt, gold, and chromate, and aromatic substances such as spices. Avoidance of the offending hapten is the most obvious treatment. For some haptens, such as nickel, diet treatment may be effective. Chelation therapy with disulfiram is another therapeutic option in nickel-allergic patients with systemic contact dermatitis. Hyposensitization therapy has been attempted with some success in systemic contact dermatitis caused by nickel and Parthenium hysterophorus.
Collapse
|
14
|
Bergschmidt P, Bader R, Mittelmeier W. Metal hypersensitivity in total knee arthroplasty: revision surgery using a ceramic femoral component - a case report. Knee 2012; 19:144-7. [PMID: 21292491 DOI: 10.1016/j.knee.2011.01.001] [Citation(s) in RCA: 52] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2010] [Revised: 01/05/2011] [Accepted: 01/07/2011] [Indexed: 02/02/2023]
Abstract
We present a case involving the revision of a total knee arthroplasty with a metal femoral component using a ceramic implant due to metal hypersensitivity. A 58-year-old female patient underwent total knee arthroplasty (TKA) with a standard metal bicondylar knee system. She suffered from persistent pain and strong limitations in her range of motion (ROM) associated with flexion during the early postoperative period. Arthroscopic arthrolysis of the knee joint and intensive active and passive physical treatment, in combination with a cortisone regime, temporarily increased the ROM and reduced pain. No signs of low grade infection or other causes of implant failure were evident. Histology of synovial tissue revealed lymphoplasmacellular fibrinous tissue, consistent with a type IV allergic reaction. Allergometry (skin reaction) revealed type IV hypersensitivity against nickel-II-sulfate and palladium chloride. Revision surgery of the metal components was performed with a cemented ceramic femoral component (same bicondylar design) and a cemented titanium alloy tibial component. Postoperative evaluations were performed 10days, and 3 and 12months after the revision surgery. There was an increased ROM in flexion to 90° at the 12month follow-up. No swelling or effusion was observed at all clinical examinations after the revision surgery. No pain at rest and moderate walking pain were evident. The presented case demonstrates that ceramic implants are a promising solution for patients suffering from hypersensitivity to metal ions in total knee arthroplasty.
Collapse
|
15
|
Bergschmidt P, Bader R, Finze S, Schulze C, Kundt G, Mittelmeier W. Comparative Study of Clinical and Radiological Outcomes of Unconstrained Bicondylar Total Knee Endoprostheses with Anti-allergic Coating. Open Orthop J 2011; 5:354-60. [PMID: 22016754 PMCID: PMC3195852 DOI: 10.2174/1874325001105010354] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/08/2011] [Revised: 08/25/2011] [Accepted: 08/26/2011] [Indexed: 11/22/2022] Open
Abstract
Background: Hypersensitivity reactions to implant materials have become more important in total knee replacement (TKR). The purpose of this retrospective comparative study was to evaluate the clinical and radiological outcomes of unconstrained bicondylar total knee prostheses with and without anti-allergic titanium(niobium)nitrite (Ti(Nb)N) coating. Methods: Twenty-four patients (25 TKRs) underwent a preoperative clinical evaluation and then a postoperative evaluation after 26.2 months in the allergy group treated with coated implants (n=13 implants) and after 24.5 months in the control group treated with uncoated implants but identical geometry (n=12) using HSS, WOMAC and SF-36 scores. Radiological evaluations were performed using standard anterior-posterior (a.p.) and lateral X-rays. Results: During follow-up two patients of the allergy group had to undergo revision surgery due to non-implant-related reasons. A comparative analysis of both study groups showed a significant difference in the HSS scores at both evaluation time points (MW test p≤0.050); these findings are remarkable since the control group had a significantly lower score preoperatively (54.0 vs 65.0 points) and a significantly higher score (82.5 vs 75.0 points) postoperatively. The preoperative and postoperative WOMAC and SF-36 scores were comparable in both groups (MW test p≥0.052), although the postoperative increase in the score for the allergy group was lower. The radiological results were comparable in both groups and were unlikely to influence the results. Conclusions: This clinical study demonstrates the restricted outcome in postoperative function and quality of life in the allergy group compared to the control group.
Collapse
Affiliation(s)
- Philipp Bergschmidt
- Department of Orthopaedics, University of Rostock, Doberaner Strasse 142, D-18057 Rostock, Germany
| | | | | | | | | | | |
Collapse
|
16
|
Causes of failure and etiology of painful primary total knee arthroplasty. Knee Surg Sports Traumatol Arthrosc 2011; 19:1418-32. [PMID: 21833512 DOI: 10.1007/s00167-011-1631-9] [Citation(s) in RCA: 73] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2011] [Accepted: 07/15/2011] [Indexed: 12/20/2022]
Abstract
The review provides an overview of the causes of failure and the many different aetiologies of a painful primary total knee arthroplasty (TKA). They can be classified into extra- and intraarticular disorders, the latter being divided into biological and mechanical origins. Whereas biological aetiologies like infections have remained stable over time, other causes of failure have changed. In the early times of knee arthroplasty, they were mainly related to technical insufficiencies. A better understanding of knee arthroplasty, patients' increasing functional demands as well as a continuous development of TKA techniques generated newer problems, which are increasingly related to the functioning of the soft-tissue envelope of the knee. From a therapeutic point of view, three situations can be considered: functional problems not needing reoperations, causes of reoperations not needing an exchange of prosthetic components as well as reoperations with exchange of at least one prosthetic component.
Collapse
|
17
|
The painful knee after TKA: a diagnostic algorithm for failure analysis. Knee Surg Sports Traumatol Arthrosc 2011; 19:1442-52. [PMID: 21822665 DOI: 10.1007/s00167-011-1634-6] [Citation(s) in RCA: 83] [Impact Index Per Article: 6.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/13/2011] [Accepted: 07/19/2011] [Indexed: 10/17/2022]
Abstract
Pain after total knee arthroplasty (TKA) represents a common observation in about 20% of the patients after surgery. Some of these painful knees require early revision surgery within 5 years. Obvious causes of failure might be identified with clinical examinations and standard radiographs only, whereas the unexplained painful TKA still remains a challenge for the surgeon. It is generally accepted that a clear understanding of the failure mechanism in each case is required prior considering revision surgery. A practical 10-step diagnostic algorithm is described for failure analysis in more detail. The evaluation of a painful TKA includes an extended history, analysis of the type of pain, psychological exploration, thorough clinical examination including spine, hip and ankle, laboratory tests, joint aspiration and test infiltration, radiographic analysis and special imaging techniques. It is also important to enquire about the length and type of conservative therapy. Using this diagnostic algorithm, a sufficient failure analysis is possible in almost all patients with painful TKA.
Collapse
|
18
|
Assoziation zwischen Benzoylperoxidallergie, Vitiligo und Implantation einer zementierten Knieprothese. DER ORTHOPADE 2011; 40:802-6. [DOI: 10.1007/s00132-011-1793-7] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
19
|
Reich J, Hovy L, Lindenmaier HL, Zeller R, Schwiesau J, Thomas P, Grupp TM. [Preclinical evaluation of coated knee implants for allergic patients]. DER ORTHOPADE 2010; 39:495-502. [PMID: 20091294 DOI: 10.1007/s00132-009-1581-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND 10-15% of the population show allergic reactions against skin contact to metals as nickel, cobalt or chromium and have thus a risk of not tolerating implants containing those materials. The relationship between periimplantary hypersensivity reaction and given cutaneous contact allergy is currently unknown. A new developed multilayer coating system is supposed to prevent long-term allergic reactions that may result from uncoated implants. METHODS Stability and function (concerning bonding durability, wear and ion release to the serum) of the multilayer coating system has been examined in a test series. RESULTS The specific architecture of the multilayer coating system evidences a very good bonding durability. The results of the test in the simulator show a reduction of wear of approximately 60% compared to the uncoated implants. Ion concentrations within the serum of the wear tests were by magnitudes lower than those measured in reference tests on uncoated components. CONCLUSION The results of the preclinical evaluation prove that the durability and function of the multilayer coating system are as intended.
Collapse
Affiliation(s)
- J Reich
- Forschung & Entwicklung, Aesculap AG, Am Aesculap-Platz, 78532, Tuttlingen, Deutschland.
| | | | | | | | | | | | | |
Collapse
|
20
|
|
21
|
Lützner J, Dinnebier G, Hartmann A, Günther KP, Kirschner S. Study rationale and protocol: prospective randomized comparison of metal ion concentrations in the patient's plasma after implantation of coated and uncoated total knee prostheses. BMC Musculoskelet Disord 2009; 10:128. [PMID: 19828019 PMCID: PMC2766373 DOI: 10.1186/1471-2474-10-128] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2009] [Accepted: 10/14/2009] [Indexed: 11/23/2022] Open
Abstract
Background Any metal placed in a biological environment undergoes corrosion. Thus, with their large metallic surfaces, TKA implants are particularly prone to corrosion with subsequent release of metal ions into the human body which may cause local and systemic toxic effects and hypersensitivity reactions, and increase cancer risk. To address this problem, a new 7-layer zirconium coating developed especially for cobalt-chrome orthopaedic implants was tested biomechanically and found to lower metal ion release. The purpose of the proposed clinical trial is to compare the metal ion concentration in patients' plasma before and after implantation of a coated or uncoated TKA implant. Methods/Design In this randomised controlled trial, 120 patients undergoing primary TKA will be recruited at the Department of Orthopaedic Surgery of the University Hospital in Dresden, Germany, and randomised to either the coated or uncoated prosthesis. Outcome assessments will be conducted preoperatively and at 3 months, 12 months and 5 years postoperatively. The primary clinical endpoint will be the chromium ion concentration in the patient's plasma after 1 and 5 years. Secondary outcomes include cobalt, molybdenum and nickel ion concentrations after 1 and 5 years, allergy testing for hypersensitivity against one of these metals, the Knee Society Score to assess clinical and physical function of the knee joint, the self-assessment Oxford Score and the Short Form 36 quality of live questionnaire. Discussion The metal ion concentration in the patient's plasma has been shown to increase after TKA, its eventual adverse effects being widely debated. In the light of this discussion, ways to reduce metal ion release from orthopaedic implants should be studied in detail. The results of this investigation may lead to a new method to achieve this goal. Trials register Clinicaltrials registry NCT00862511
Collapse
Affiliation(s)
- Jörg Lützner
- Department of Orthopaedic Surgery, University Hospital Carl Gustav Carus, Medical Faculty of the Technical University of Dresden, Germany.
| | | | | | | | | |
Collapse
|