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Mutsuzaki H, Yashiro H, Kakehata M, Oyane A, Ito A. Femtosecond Laser Irradiation to Zirconia Prior to Calcium Phosphate Coating Enhances Osteointegration of Zirconia in Rabbits. J Funct Biomater 2024; 15:42. [PMID: 38391895 PMCID: PMC10889465 DOI: 10.3390/jfb15020042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/16/2023] [Revised: 01/31/2024] [Accepted: 02/04/2024] [Indexed: 02/24/2024] Open
Abstract
Calcium phosphate (CaP) coating of zirconia and zirconia-based implants is challenging, due to their chemical instability and susceptibility to thermal and mechanical impacts. A 3 mol% yttrium-stabilized tetragonal zirconia polycrystal was subjected to femtosecond laser (FsL) irradiation to form micro- and submicron surface architectures, prior to CaP coating using pulsed laser deposition (PLD) and low-temperature solution processing. Untreated zirconia, CaP-coated zirconia, and FsL-irradiated and CaP-coated zirconia were implanted in proximal tibial metaphyses of male Japanese white rabbits for four weeks. Radiographical analysis, push-out test, alizarin red staining, and histomorphometric analysis demonstrated a much improved bone-bonding ability of FsL-irradiated and CaP-coated zirconia over CaP-coated zirconia without FsL irradiation and untreated zirconia. The failure strength of the FsL-irradiated and CaP-coated zirconia in the push-out test was 6.2-13.1-times higher than that of the CaP-coated zirconia without FsL irradiation and untreated zirconia. Moreover, the adhesion strength between the bone and FsL-irradiated and CaP-coated zirconia was as high as that inducing host bone fracture in the push-out tests. The increased bone-bonding ability was attributed to the micro-/submicron surface architectures that enhanced osteoblastic differentiation and mechanical interlocking, leading to improved osteointegration. FsL irradiation followed by CaP coating could be useful for improving the osteointegration of cement-less zirconia-based joints and zirconia dental implants.
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Affiliation(s)
- Hirotaka Mutsuzaki
- Center for Medical Science, Ibaraki Prefectural University of Health Sciences, 4669-2 Ami, Ibaraki 300-0394, Japan
- Department of Orthopaedic Surgery, Ibaraki Prefectural University of Health Sciences Hospital, 4773 Ami, Ibaraki 300-0331, Japan
| | - Hidehiko Yashiro
- Research Institute for Advanced Electronics and Photonics, National Institute of Advanced Industrial Science and Technology (AIST), AIST Tsukuba Central 2, 1-1-1 Umezono, Tsukuba, Ibaraki 305-8568, Japan
| | - Masayuki Kakehata
- Research Institute for Advanced Electronics and Photonics, National Institute of Advanced Industrial Science and Technology (AIST), AIST Tsukuba Central 2, 1-1-1 Umezono, Tsukuba, Ibaraki 305-8568, Japan
| | - Ayako Oyane
- Nanomaterials Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), AIST Tsukuba Central 5, 1-1-1 Higashi, Tsukuba, Ibaraki 305-8565, Japan
| | - Atsuo Ito
- Health and Medical Research Institute, National Institute of Advanced Industrial Science and Technology (AIST), AIST Tsukuba Central 6, 1-1-1 Higashi, Tsukuba, Ibaraki 305-8566, Japan
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2
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Tang J, Sang Z, Zhang X, Song C, Tang W, Luo X, Yan M. Impacts of residual 3D printing metal powders on immunological response and bone regeneration: an in vivo study. JOURNAL OF MATERIALS SCIENCE. MATERIALS IN MEDICINE 2023; 34:29. [PMID: 37227574 DOI: 10.1007/s10856-023-06727-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Subscribe] [Scholar Register] [Received: 11/19/2022] [Accepted: 04/03/2023] [Indexed: 05/26/2023]
Abstract
Residual powder is a defect in powder bed fusion-based additive manufacturing (3D printing), and it is difficult to completely remove it from as-printed materials. In addition, it is not necessary to apply 3D printed implants with residual powder in the clinic. The immunological response triggered by the residual powder is an important area of study in medical research. To further understand the possible immunological reactions and hidden dangers caused by residual powders in vivo, this study compared the immunological reactions and osteolysis caused by typical powders for four implant materials: 316 L stainless steel, CoCrMo, CP-Ti, and Ti-6Al-4V (particle size range of 15-45 μm), in a mouse skull model. Furthermore, the possible immunological responses and bone regeneration induced by the four 3D printed implants with residual powder in a rat femur model were compared. In the mouse skull model, it was found that the 316L-S, CoCrMo-S, and especially the 316L-M powders, upregulated the expression of pro-inflammatory factors, increased the ratio of RANKL/OPG, and activated more functional osteoclasts, resulting in more severe bone resorption compared with those in other groups. In the rat femur model, which is more suitable for clinical practice, there is no bone resorption in implants with residual powders, but they show good bone regeneration and integration ability because of their original roughness. The results indicate that the expressions of inflammatory cytokines in all experimental groups were the same as those in the control group, showing good biological safety. The results answered some critical questions related to additively manufactured medical materials in vivo and indicated that as-printed implants may have great potential in future clinical applications.
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Affiliation(s)
- Jincheng Tang
- Department of Materials Science and Engineering, Southern University of Science and Technology, Shenzhen, 518055, China
| | - Zhuo Sang
- The Eighth Affiliated Hospital, Sun Yat- sen University, Shenzhen, 518033, China.
| | - Xiaolei Zhang
- The Eighth Affiliated Hospital, Sun Yat- sen University, Shenzhen, 518033, China
| | - Changhui Song
- Department of Mechanical and Automotive Engineering, South China University of Technology, Guangzhou, 510641, China
| | - Wei Tang
- Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Shenzhen, 518055, China
| | - Xiaoping Luo
- Nanjing Stomatological Hospital Medical School of Nanjing University, Nanjing, 210008, China
| | - Ming Yan
- Department of Materials Science and Engineering, Southern University of Science and Technology, Shenzhen, 518055, China.
- Jiaxing Research Institute, Southern University of Science and Technology, Jiaxing, 314001, China.
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3
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Dadkhahfar S, Chehrassan M, Faldini C. Hypersensitivity reactions to metals in spine surgery. Musculoskelet Surg 2023; 107:29-35. [PMID: 36344900 DOI: 10.1007/s12306-022-00765-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2022] [Accepted: 10/05/2022] [Indexed: 11/09/2022]
Abstract
Hypersensitivity to orthopedic devices is a rare condition with an underestimated incidence due to the lack of diagnostic guideline and ambiguous clinical manifestations. Although hypersensitivity to metal is common, a few cases of hypersensitivity reactions have been reported after spinal instrumentation. Spinal fusion and stabilization require a wide range of devices such as screws, wires, bands, and artificial disk replacement devices. Spinal instrumented surgeries are different from total joint arthroplasty in several aspects such as degree and pattern of motion, loading environment, and adjacent tissues with distinct characteristics. The interval for hypersensitivity reactions to occur after spinal metallic implantation is usually weeks to months. The present review covers the topic of hypersensitivity reactions that have been reported after spinal surgeries with the focus on cutaneous presentations.
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Affiliation(s)
- S Dadkhahfar
- Skin Research Center, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - M Chehrassan
- Bone and Joint Reconstruction Research Center, Shafa Orthopedic Hospital, Iran University of Medical Sciences, Tehran, Iran.
| | - C Faldini
- Istituto Orthopedico Rizzoli, Bologna, Italy
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Ahmed NE, Varghese R, Abdel-Khalek A, Tariq A, Yu T, Ganeshalingam S, Hollis CC, Amos-Arowoshegbe EO, Nasser Deen K, Tiesenga F. Mixed Metal Allergy Ancillary to Surgical Staples. Cureus 2022; 14:e26899. [PMID: 35983386 PMCID: PMC9376058 DOI: 10.7759/cureus.26899] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 07/15/2022] [Indexed: 11/05/2022] Open
Abstract
Metal allergies to surgical clips are atypical and often neglected as a differential. It becomes even more unexpected when there is a lack of relevant medical history of the patient reacting poorly to known metals. This study entails the unique finding of newly discovered hypersensitivity to nickel and zirconium, metals commonly found in surgical clips, in a 28-year-old female who underwent laparoscopic cholecystectomy with a cholangiogram.
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Lazarenko HO, Boiko IV. THE METHOD OF ATOMIC FORCE MICROSCOPY AS A POSSIBLE TOOL FOR TESTING THE BIOCOMPATIBILITY OF IMPLANTS IN TRAUMATOLOGY AND ORTHOPEDICS PRACTICE. WIADOMOSCI LEKARSKIE (WARSAW, POLAND : 1960) 2022; 75:2614-2618. [PMID: 36591742 DOI: 10.36740/wlek202211111] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/17/2023]
Abstract
OBJECTIVE The aim: To establish the possibility of using the atomic force microscope (AFM) to predict the body's reaction to the implant. PATIENTS AND METHODS Materials and methods: A total of 32 patients, 22 men and 10 women, the average age of the patients was 55±6 years, were included in the study. They performed pre- and post-operative testing of the biocompatibility of orthopedic implant materials with the patient's body with the help of AFM. RESULTS Results: According to the research, an increase in pro-inflammatory factors was found, which may indicate a constant inflammatory process, which is probably related to the presence of the implant. CONCLUSION Conclusions: On the basis of atomic force spectroscopy, an express method of testing biomaterials for compatibility with the body of a specific recipient and studying the effect of the reactions of recipient tissues on the surface of various implants has been developed. The obtained results can be useful in planning further clinical studies.
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Affiliation(s)
- Hlib O Lazarenko
- STATE INSTITUTION OF SCIENCE «RESEARCH AND PRACTICAL CENTER OF PREVENTIVE AND CLINICAL MEDICINE», KYIV, UKRAINE, STATE ADMINISTRATIVE DEPARTMENT, KYIV, UKRAINE
| | - Igor V Boiko
- STATE INSTITUTION OF SCIENCE «RESEARCH AND PRACTICAL CENTER OF PREVENTIVE AND CLINICAL MEDICINE», KYIV, UKRAINE, STATE ADMINISTRATIVE DEPARTMENT, KYIV, UKRAINE
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Monti L, Franchi E, Ursino N, Mariani I, Corona K, Anghilieri FM, D’Ambrosi R. Hypoallergenic unicompartmental knee arthroplasty and return to sport: comparison between Oxidized Zirconium and Titanium Niobium Nitride. ACTA BIO-MEDICA : ATENEI PARMENSIS 2022; 93:e2022160. [PMID: 35775764 PMCID: PMC9335424 DOI: 10.23750/abm.v93i3.12677] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/11/2021] [Accepted: 02/08/2022] [Indexed: 11/28/2022]
Abstract
BACKGROUND The present study aims to compare the rate of return to sports in patients who underwent surgery for mobile-bearing UKA with either hypoallergenic TiNbN or with oxidized zirconium alloy implants. METHODS The records of two consecutive cohorts for a total of 90 hypoallergenic implants were prospectively analysed. The first cohort consisted of 41 consecutive series of medial mobile-bearing hypoallergenic TiNbN UKA, whereas the second cohort consisted of 49 consecutive medial fixed-bearing hypoallergenic Uni Oxinium.The clinical evaluation involved evaluating each patient's University of California, Los Angeles (UCLA) activity scoresand the High-Activity Arthroplasty Score(HAAS). Each patient was clinically evaluated on the day before surgery (T0), then after a minimum follow-up period of 12 months (T1), and finally after 24 months (T2). Results:The only pre-operative difference between the two groups involved pre-operative BMI with significantly higher BMI in TiNbN Group (p<0.001). Both groups reported significant improvement at each follow-up compared with the previous and also at the final follow up with respect to UCLA and HAAS (p<0.05), except for UCLA in TiNbN between T1 and T2(p>0.05). Moreover, BMI improved significantly at the final follow up, but only in TiNbN group (p<0.05). CONCLUSIONS Both TiNbN and Oxinium UKA procedures enabled patients to return to an acceptable level of sports activity with excellent radiographic outcomes after the final follow up regardless of the age, gender, BMI, and bearing type.
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Affiliation(s)
| | | | - Nicola Ursino
- IRCCS Istituto Ortopedico Galeazzi, Via Galeazzi 4, 20161, Milan, Italy
| | - Ilaria Mariani
- Institute for Maternal and Child Health – IRCCS “Burlo Garofolo” – Trieste, Italy
| | - Katia Corona
- Università degli Studi del Molise, Dipartimento di Medicina e Scienze della Salute Vincenzo, Tiberio, Campobasso, Italy
| | - Filippo Maria Anghilieri
- Dipartimento di Scienze Biomediche per la Salute, Università degli Studi di Milano, Milan, Italy
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No Clinical or Radiographic Differences Between Cemented Cobalt-Chromium and Titanium-Niobium Nitride Mobile-Bearing Unicompartmental Knee Arthroplasty. Indian J Orthop 2021; 55:1195-1201. [PMID: 34824720 PMCID: PMC8586226 DOI: 10.1007/s43465-021-00486-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/01/2021] [Accepted: 08/10/2021] [Indexed: 02/04/2023]
Abstract
PURPOSE This study aimed to compare the clinical and radiographic outcomes of patients with positive patch tests undergoing a medial mobile-bearing titanium-niobium nitride (TiNbN) unicompartmental knee arthroplasty (UKA) to patients undergoing standard UKA (cobalt-chromium [CoCr] implants). METHODS Two successive groups of patients, amounting to a total of 246 individuals, who received Oxford (Zimmer-Biomet, Warsaw, Indiana, USA) UKA were included. The first group was composed of a series of 203 consecutive standard CoCr UKAs (Standard Group), while the second group comprised 43 consecutive hypoallergenic TiNbN UKAs (HA group). The patients of the second group had a positive epicutaneous patch test result for metals. Each patient was evaluated using the Oxford Knee Score (OKS) and Knee Society Score (KSS) a day prior to the surgery (T 0) and at two consecutive follow-ups, namely T 1 (minimum follow-up of 12 months) and T 2 (minimum follow-up of 34 months). Radiographic measurements were performed at the final follow-up (T 2). RESULTS No statistical differences were noted between the two groups regarding demographic data (p > 0.05). No clinical or radiographic differences were found between the HA and standard groups at any follow-up (p > 0.05). A statistically significant improvement was found at any follow-up for both OKS and KSS (p < 0.05). CONCLUSIONS No clinical or radiographic differences between the hypoallergenic and standard cobalt-chromium groups at any follow-up were found, with a clinically significant improvement being experienced by both groups during the entire follow-up. LEVEL OF EVIDENCE Level II-comparative prospective study. SUPPLEMENTARY INFORMATION The online version contains supplementary material available at 10.1007/s43465-021-00486-3.
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Sagoo NS, Sharma R, Alaraj S, Sharma IK, Bruntz AJ, Bajaj GS. Metal Hypersensitivity and Complex Regional Pain Syndrome After Bilateral Total Knee Arthroplasty: A Case Report. JBJS Case Connect 2021; 11:01709767-202109000-00059. [PMID: 34854434 DOI: 10.2106/jbjs.cc.21.00099] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
CASE A 38-year-old man underwent bilateral total knee arthroplasty (TKA) and subsequently developed diffuse pain, swelling, and an eczematous rash that spread throughout his body. Despite various pharmacological regimens, sympathetic blocks, aggressive physical therapy, and further knee revisions, the patient's symptoms progressed over a period of 2 years. An in vitro memory lymphocyte immuno-stimulation assay test demonstrated reactivity to nickel after which bilateral revision TKAs with oxidized zirconium alloys resulted in symptomatic improvement. CONCLUSION Metal hypersensitivity should be considered after the exclusion of infection; however, the concurrent development of complex regional pain syndrome may mask the clinical presentation.
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Affiliation(s)
- Navraj S Sagoo
- The University of Texas Medical Branch, Galveston, Texas
| | - Ruhi Sharma
- Ross University School of Medicine, Miramar, Florida
| | - Sami Alaraj
- The University of Texas Medical Branch, Galveston, Texas
| | | | - Adam J Bruntz
- Lone Star Orthopaedic and Spine Specialists, Fort Worth, Texas
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Schneiderman BA, Yang S, Dipane M, Lu C, McPherson EJ, Schmalzried TP. Periprosthetic Tissue Reaction Independent of LTT Result and Implanted Materials in Total Knee Arthroplasty. J Arthroplasty 2021; 36:2480-2485. [PMID: 33714633 DOI: 10.1016/j.arth.2021.02.036] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/29/2020] [Revised: 02/08/2021] [Accepted: 02/11/2021] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND An allergic reaction may rarely cause a painful or stiff total knee arthroplasty (TKA). However, no consensus diagnostic criteria for TKA immune failure exist. Lymphocyte transformation testing (LTT) measures immune sensitivity to various materials, but its role in diagnosing an allergic reaction to a TKA has not been established. This study compares TKA periprosthetic tissues in a) LTT-positive versus -negative patients and b) patients with conventional CoCrNi versus hypoallergenic implants. METHODS Periprosthetic tissues from 26 revision cases of well-fixed, aseptic, but painful or stiff TKAs were analyzed. Twelve patients LTT positive for nickel (Ni) were matched as a cohort to 6 LTT-negative patients. In 4 patients LTT positive for Ni, tissue from first revision of CoCrNi implants was compared with tissue from subsequent revision of hypoallergenic implants. Histology was evaluated using the aseptic lymphocyte-dominated vasculitis-associated lesion (ALVAL) score. RESULTS No correlation was found between LTT and any ALVAL score component. The mean total ALVAL score was 3.8 ± 1.5 for LTT-negative patients and 3.3 ± 1.2 for LTT-positive patients (P = .44). The mean total ALVAL score at revision of CoCrNi implants was 3.0 ± 1.8 compared with 5.8 ± 0.5 at rerevision of hypoallergenic implants (P = .053). CONCLUSION Periprosthetic TKA tissue reactions were indistinguishable between LTT-positive and -negative patients. LTT does not predict the periprosthetic tissue response. ALVAL scores of hypoallergenic revision implant tissue trended higher than primary CoCrNi implant tissue. A positive LTT may not indicate that a periprosthetic immune reaction is the cause of pain and stiffness after TKA. LEVEL OF EVIDENCE 3, retrospective cohort study.
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Affiliation(s)
| | - Steven Yang
- Department of Orthopaedic Surgery, Harbor-UCLA Medical Center, Torrance CA
| | - Matthew Dipane
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Conrad Lu
- Joint Replacement Institute at St. Vincent Medical Center, Los Angeles CA
| | - Edward J McPherson
- Department of Orthopaedic Surgery, David Geffen School of Medicine at UCLA, Los Angeles, CA
| | - Thomas P Schmalzried
- Department of Orthopaedic Surgery, Harbor-UCLA Medical Center, Torrance CA; Joint Replacement Institute at St. Vincent Medical Center, Los Angeles CA
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Metal Hypersensitivity in Joint Arthroplasty. JOURNAL OF THE AMERICAN ACADEMY OF ORTHOPAEDIC SURGEONS GLOBAL RESEARCH AND REVIEWS 2021; 5:01979360-202103000-00007. [PMID: 33720103 PMCID: PMC7963506 DOI: 10.5435/jaaosglobal-d-20-00200] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/02/2020] [Accepted: 01/31/2021] [Indexed: 11/18/2022]
Abstract
Metal hypersensitivity in joint arthroplasty is a very controversial topic with limited evidence. With increasing numbers of joint replacements being done annually, a clear understanding of the pathogenesis, clinical picture, preimplant screening, postimplant workup, and treatment plan is crucial. This review article looked at all the available evidence regarding metal hypersensitivity and summarized the key findings. An algorithm was also proposed for preimplant screening, postimplant workup, and management.
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D'Ambrosi R, Nuara A, Mariani I, Di Feo F, Ursino N, Hirschmann M. Titanium Niobium Nitride Mobile-Bearing Unicompartmental Knee Arthroplasty Results in Good to Excellent Clinical and Radiographic Outcomes in Metal Allergy Patients With Medial Knee Osteoarthritis. J Arthroplasty 2021; 36:140-147.e2. [PMID: 32773267 DOI: 10.1016/j.arth.2020.07.028] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/04/2020] [Revised: 07/05/2020] [Accepted: 07/11/2020] [Indexed: 02/02/2023] Open
Abstract
BACKGROUND The main purpose of the present study was to analyze the clinical and radiological outcomes of patients with positive skin patch tests who underwent medial mobile-bearing titanium niobium nitride unicompartmental knee arthroplasty (UKA) during a mid-term follow-up. METHODS Thirty-seven patients with positive skin patch tests were included in this prospective study. The clinical evaluation consisted of Oxford Knee Score and Knee Society Score (KSS) reports. Each patient was clinically evaluated the day before surgery (T0) as well as at T1 (11.9 ± 1.3 months) and during the final follow-up T2 (67.2 ± 19.1 months). The positioning of the UKA was evaluated during the final follow-up using standardized radiographs (T2: 67.2 ± 19.1 months). RESULTS Oxford and KSS ranged from a respective mean preoperative value of 23.0 ± 2.7 and 51.5 ± 5.0 to 42.1 ± 1.7 and 87.6 ± 2.2, respectively, at T1 (P < .001) and to the final values of 45.0 ± 1.9 and 91.9 ± 3.4, respectively, at T2 (P < .001 both vs T1 and T2). At T2, the mean femoral angle was 7.0° ± 4.5°, mean tibial angle was 3.0° ± 2.1°, and mean tibial slope was 5.1° ± 3.2°. A significant difference was found between KSS and Oxford with ANOVA for repeated measures over time (P < .001). The Oxford and KSS scores showed significant improvements during each follow-up. No complications were found, and not a single patient required a revision surgery during the follow-up period. CONCLUSION The hypoallergenic titanium niobium nitride mobile-bearing UKA showed comparable results to standard CoCr UKA regardless of the gender, age, BMI, and implant size of metal allergy patients with medial knee osteoarthritis. Careful patient selection processes and accurate medical histories played key roles in the choice of hypersensitivity-friendly implants.
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Affiliation(s)
| | - Alessandro Nuara
- IRCCS Istituto Ortopedico Galeazzi, Milan, Italy; Università degli Studi di Milano, Milan, Italy
| | | | | | | | - Michael Hirschmann
- Department of Orthopaedic Surgery and Traumatology, Kantonsspital Baselland, Baselland, Switzerland
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12
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Atilla HA, Çevik HB, Akdoğan M, Aslan H. Self-reported metal hypersensitivity in patients undergoing unicondylar knee arthroplasty. J Clin Orthop Trauma 2020; 14:17-21. [PMID: 33680813 PMCID: PMC7919954 DOI: 10.1016/j.jcot.2020.10.002] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2020] [Revised: 09/20/2020] [Accepted: 10/01/2020] [Indexed: 01/16/2023] Open
Abstract
OBJECTIVES There is ongoing discussion about arthroplasty surgery of patients with metal hypersensitivity. The aim of this study was to compare the functional outcomes and eosinophil counts of unicondylar knee arthroplasty (UKA) patients with and without a history of metal hypersensitivity. METHODS A retrospective review was made of the medical records of 148 extremities of 140 consecutive patients who underwent primary UKA between January 2016 and December 2017. The patients who met the inclusion criteria were screened for history of metal hypersensitivity using a questionnaire. The functional outcomes of patients and eosinophil levels were evaluated immediately before and at 6 weeks after surgery. RESULTS The mean follow-up period was 37 months (range, 18-48 months). Of the total 128 patients, 13 (10.2%) reported a history of metal hypersensitivity before the operation. There was no statistically significant difference between patients with or without a history of metal hypersensitivity in respect of the functional outcomes or eosinophil counts (p > 0.05). CONCLUSIONS The results of this study showed that the functional outcomes of patients who underwent UKA using a standard alloy did not change between the groups who reported having or not having a history of metal hypersensitivity. Although the study also showed that the eosinophil counts decreased after surgery compared to the preoperative counts, there was no statistical relationship between the eosinophil count and functional outcomes or metal hypersensitivity history.
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13
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Kim J. A rare case of delayed hypersensitivity reaction to metal ions secondary to a remnant pedicle screw fragment after spinal arthrodesis. ACTA ORTHOPAEDICA ET TRAUMATOLOGICA TURCICA 2020; 54:461-464. [PMID: 32554366 DOI: 10.5152/j.aott.2020.20148] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Delayed hypersensitivity reaction to metal ions is rare and has been mostly documented among patients undergoing total joint arthroplasty with metal-on-metal bearing surfaces. Nonetheless, to our knowledge, only a few cases associated with spinal arthrodesis have been reported in the literature. The aim of this case report was to describe the clinical features of a rare case of delayed-type hypersensitivity reaction to nickel that occurred after an extraordinarily long period of time (approximately 15 years) after spinal arthrodesis. Here, we present a 38-year-old patient who was referred to us with a diagnosis of delayed-type hypersensitivity reaction to nickel that was established by a skin patch test. The chief sign and symptoms of the patient were allergic contact dermatitis along with intractable, generalized itching that started several months ago. The medical history revealed that the patient had undergone spinal arthrodesis using rods and pedicle screws approximately 15 years ago, followed by revision surgery to remove the implants. Radiological examination showed a remnant pedicle screw fragment at the third lumbar vertebra that had broken off during the removal of implants nine years ago. However, the signs and symptoms of metal hypersensitivity started shortly before the patient was referred to our hospital. We decided to remove the screw fragment as allergic contact dermatitis was refractory to medical treatment. On postoperative day one, the itching was completely resolved, although the skin patch test remained positive.
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Affiliation(s)
- Jiha Kim
- Department of Neurosurgery, Kangwon National University, School of Medicine, Kangwon National University Hospital, Chuncheon-Si, Gangwon-Do, South Korea
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14
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Oai K, Inoue Y, Nakao A, Fukazawa K, Ishihara K. Antibacterial effect of nanometer‐size grafted layer of quaternary ammonium polymer on poly(ether ether ketone) substrate. J Appl Polym Sci 2020. [DOI: 10.1002/app.49088] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Affiliation(s)
- Keiko Oai
- Department of Materials Engineering, School of EngineeringThe University of Tokyo Tokyo Japan
| | - Yuuki Inoue
- Department of Materials Engineering, School of EngineeringThe University of Tokyo Tokyo Japan
| | | | - Kyoko Fukazawa
- Department of Materials Engineering, School of EngineeringThe University of Tokyo Tokyo Japan
| | - Kazuhiko Ishihara
- Department of Materials Engineering, School of EngineeringThe University of Tokyo Tokyo Japan
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15
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Zondervan RL, Vaux JJ, Blackmer MJ, Brazier BG, Taunt CJ. Improved outcomes in patients with positive metal sensitivity following revision total knee arthroplasty. J Orthop Surg Res 2019; 14:182. [PMID: 31208448 PMCID: PMC6580588 DOI: 10.1186/s13018-019-1228-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2019] [Accepted: 06/05/2019] [Indexed: 02/06/2023] Open
Abstract
Background Metal sensitivity as a cause for painful joint replacement has become increasingly prevalent; however, there is a lack of reported clinical outcome data from total knee arthroplasty patients with metal allergies. The purpose of this study was to determine whether patients presenting with a painful total knee arthroplasty with a positive metal sensitivity have improved outcomes following revision to a hypoallergenic implant. Methods A retrospective review was conducted for patients that underwent a revision total knee arthroplasty after metal sensitivity testing over a 3-year period from January 1, 2015, to December 31, 2017. Based on the results of sensitivity testing, patients underwent revision total knee arthroplasty to a hypoallergenic component or a standard component. Following revision, patients returned to the clinic at an interval of 6 weeks, 5 months, and 12 months for functional, pain, and satisfaction assessment. Outcomes were compared within and between sensitivity groups. Results Of the included patients, 78.3% (39/46) were positive for metal sensitivity. The most common metal sensitivity was to nickel (79.5%, 32/39). Both non-reactive and reactive patients significantly improved in range of motion after revision arthroplasty. The reactive group saw a 37.8% decrease in pain at 6 weeks post-revision (p < 0.001) Whereas, the non-reactive group only saw a moderate, non-significant improvement in pain reduction at 6 weeks post-revision (27.0%; p = 0.29). Frequency of pain experienced did not vary significantly between groups. Maximum metal lymphocyte transformation test (LTT) sensitivity score did not correlate with pain level at the time of revision (R2 = 0.02, p = 0.38) or percent improvement after revision (R2 = 0.001, p = 0.81). Overall, all patients reported being very satisfied after revision total knee arthroplasty; there was no difference between positive and negative sensitivity groups (W = 62, p = 0.89). Conclusions Patients presenting with a painful knee arthroplasty and positive metal LTT have improved pain scores, walking function, and range of motion following revision to a hypoallergenic component. This study also provides a treatment algorithm for patients presenting with a painful knee replacement, in order to provide effective and timely diagnosis and management. Electronic supplementary material The online version of this article (10.1186/s13018-019-1228-4) contains supplementary material, which is available to authorized users.
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Affiliation(s)
- Robert L Zondervan
- Michigan State University College of Osteopathic Medicine, 965 Wilson Rd, East Lansing, MI, 48824, USA.
| | - Jonathan J Vaux
- McLaren Orthopedic Hospital, 2727 S Pennsylvania Ave, Lansing, MI, 48910, USA
| | - Michael J Blackmer
- McLaren Orthopedic Hospital, 2727 S Pennsylvania Ave, Lansing, MI, 48910, USA
| | - Brett G Brazier
- Michigan State University College of Osteopathic Medicine, 965 Wilson Rd, East Lansing, MI, 48824, USA
| | - Charles J Taunt
- McLaren Orthopedic Hospital, 2727 S Pennsylvania Ave, Lansing, MI, 48910, USA
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Bouguennec N, Colombet P, Graveleau N, Jambou S. The Migratory Cortical Button: A Rare Case of Hypersensitivity to Titanium after an Anterior Cruciate Ligament Reconstruction. Knee Surg Relat Res 2019; 31:132-136. [PMID: 30893989 PMCID: PMC6561671 DOI: 10.5792/ksrr.18.072] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/02/2018] [Revised: 01/03/2019] [Accepted: 01/20/2019] [Indexed: 11/04/2022] Open
Abstract
Allergy to metal, especially to titanium, is a poorly known subject in orthopedic surgery and is mostly found after arthroplasty. Here, we describe an original case of titanium allergy that developed after an anterior cruciate ligament (ACL) reconstruction of the left knee in a patient with a history of severe atopic dermatitis. Three years after the surgery, he returned to the clinic with the femoral cortical button in his hand; he removed the device from the wound when the skin spontaneously opened at the lateral part of the thigh. The wound healed with dressings without use of any antibiotics. Clinical and functional results were favorable and magnetic resonance imaging signal of the graft was normal. We ruled out the possibility of infection and the final diagnosis was allergy to titanium. This case demonstrates the need to investigate the presence of allergy to metal, including titanium, before an ACL reconstruction.
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