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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.
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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.
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2
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Sadrolvaezin A, Pezhman A, Zare I, Nasab SZ, Chamani S, Naghizadeh A, Mostafavi E. Systemic allergic contact dermatitis to palladium, platinum, and titanium: mechanisms, clinical manifestations, prevalence, and therapeutic approaches. MedComm (Beijing) 2023; 4:e386. [PMID: 37873514 PMCID: PMC10590457 DOI: 10.1002/mco2.386] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2022] [Revised: 09/04/2023] [Accepted: 09/08/2023] [Indexed: 10/25/2023] Open
Abstract
Contact dermatitis (CD) is an inflammatory skin disease of eczema that is elicited by chemicals or metal ions that have toxic effects without eliciting a T-cell response (contact elicitation) or by small reactive chemicals that modify proteins and induce innate and adaptive immune responses (contact allergens). The clinical condition is characterized by localized skin rash, pruritus, redness, swelling, and lesions, which are mainly detected by patch tests and lymphocyte stimulation. Heavy metals such as palladium (Pd), platinum (Pt), and titanium (Ti) are ubiquitous in our environment. These heavy metals have shown CD effects as allergic agents. Immunological responses result from the interaction of cytokines and T cells. Occupational metal CD accounts for most cases of work-related cutaneous disorders. In this systematic review, the allergic effects of heavy metals, including Pd, Pt, and Ti, and the mechanisms, clinical manifestations, prevalence, and therapeutic approaches are discussed in detail. Furthermore, the therapeutic approaches introduced to treat CD, including corticosteroids, topical calcineurin inhibitors, systemic immunosuppressive agents, phototherapy, and antihistamines, can be effective in the treatment of these diseases in the future. Ultimately, the insights identified could lead to improved therapeutic and diagnostic pathways.
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Affiliation(s)
- Ali Sadrolvaezin
- Medical Toxicology and Drug Abuse Research CenterBirjand University of Medical SciencesBirjandIran
| | - Arezou Pezhman
- School of MedicineZahedan Azad University of Medical SciencesZahedanIran
| | - Iman Zare
- Research and Development DepartmentSina Medical Biochemistry Technologies Co. Ltd.ShirazIran
| | - Shima Zahed Nasab
- Department of Life Science EngineeringFaculty of New Sciences and TechnologiesUniversity of TehranTehranIran
| | - Sajad Chamani
- Medical Toxicology and Drug Abuse Research CenterBirjand University of Medical SciencesBirjandIran
| | - Ali Naghizadeh
- Medical Toxicology and Drug Abuse Research CenterBirjand University of Medical SciencesBirjandIran
| | - Ebrahim Mostafavi
- Stanford Cardiovascular InstituteStanford University School of MedicineStanfordCaliforniaUSA
- Department of MedicineStanford University School of MedicineStanfordCaliforniaUSA
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3
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Pautasso A, Zorzolo I, Bellato E, Pellegrino P, Ferrario A, Pira E, Castoldi F. Allergic reaction and metal hypersensitivity after shoulder joint replacement. Musculoskelet Surg 2023; 107:55-68. [PMID: 34719773 PMCID: PMC10020248 DOI: 10.1007/s12306-021-00729-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 09/17/2021] [Indexed: 06/13/2023]
Abstract
PURPOSE Metal ion release may cause local and systemic effects and induce hypersensitivity reactions. The aim of our study is first to determine if implant-related hypersensitivity correlates to patient symptoms or not; second, to assess the rate of hypersensitivity and allergies in shoulder arthroplasty. METHODS Forty patients with shoulder replacements performed between 2015 and 2017 were studied with minimum 2-year follow-up; no patient had prior metal implants. Each patient underwent radiographic and clinical evaluation using the Constant-Murley Score (CMS), 22 metal and cement haptens patch testing, serum and urine tests to evaluate 12 metals concentration, and a personal occupational medicine interview. RESULTS At follow-up (average 45 ± 10.7 months), the mean CMS was 76 ± 15.9; no clinical complications or radiographic signs of loosening were detected; two nickel sulfate (5%), 1 benzoyl peroxide (2.5%) and 1 potassium dichromate (2.5%) positive findings were found, but all these patients were asymptomatic. There was an increase in serum aluminum, urinary aluminum and urinary chromium levels of 1.74, 3.40 and 1.83 times the baseline, respectively. No significant difference in metal ion concentrations were found when patients were stratified according to gender, date of surgery, type of surgery, and type of implant. CONCLUSIONS Shoulder arthroplasty is a source of metal ion release and might act as a sensitizing exposure. However, patch test positivity does not seem to correlate to hypersensitivity cutaneous manifestations or poor clinical results. Laboratory data showed small constant ion release over time, regardless of gender, type of shoulder replacement and implant used. LEVELS OF EVIDENCE Level II.
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Affiliation(s)
- A. Pautasso
- University of Turin, Via Gianfranco Zuretti 29, 10126 Turin, Italy
| | - I. Zorzolo
- University of Turin, Via Gianfranco Zuretti 29, 10126 Turin, Italy
| | - E. Bellato
- Orthopaedic and Traumatology Department, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole 10, 10043 Orbassano, Italy
| | - P. Pellegrino
- Oncologic Orthopaedic Department, Orthopaedic and Trauma Center – Città della Salute e della Scienza, University of Turin, Via Gianfranco Zuretti 29, 10126 Turin, Italy
| | - A. Ferrario
- Occupational Medicine Division, Department of Public Health and Pediatric Sciences, Orthopaedic and Trauma Center – Città della Salute e della Scienza, University of Turin, Via Gianfranco Zuretti 29, 10126 Turin, Italy
| | - E. Pira
- University of Turin, Via Gianfranco Zuretti 29, 10126 Turin, Italy
- Occupational Medicine Division, Department of Public Health and Pediatric Sciences, Orthopaedic and Trauma Center – Città della Salute e della Scienza, University of Turin, Via Gianfranco Zuretti 29, 10126 Turin, Italy
| | - F. Castoldi
- University of Turin, Via Gianfranco Zuretti 29, 10126 Turin, Italy
- Orthopaedic and Traumatology Department, San Luigi Gonzaga Hospital, University of Turin, Regione Gonzole 10, 10043 Orbassano, Italy
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Battaglia AG, Ali-Zade C, Monti L, Al Khawashki H, Winkler H, Del Sel H, Mavrogenis AF, Benzakour T, Drago L, Romanò CL. Metal Hypersensitivity or Missed Periprosthetic Joint Infection? A Critical Review. Orthopedics 2022; 45:e73-e78. [PMID: 34978510 DOI: 10.3928/01477447-20211227-04] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
The World Association Against Infection in Orthopedics And Trauma (W.A.I.O.T.) Study Group on Bone And Joint Infection Definitions Metal hypersensitivity (MHS) has been investigated by several authors as a possible reason for painful total joint arthroplasty, with controversial results. Periprosthetic joint infection (PJI) is another possible source of unexplained pain and implant failure that may be difficult to diagnose if not properly investigated. We performed this critical review to assess whether the current literature on MHS includes an adequate diagnostic workup to discern metal allergy from PJI. The results of this review highlight the importance of assessing patients for PJI before making a diagnosis of MHS and emphasize that the methods currently used to exclude PJI are substantially inadequate. Therefore, well-designed clinical trials with adequate diagnostic protocols and definitions of PJI that can differentiate MHS from low-grade PJI are needed. [Orthopedics. 2022;45(2):e73-e78.].
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5
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Christiansen RJ, Münch HJ, Bonefeld CM, Thyssen JP, Sloth JJ, Geisler C, Søballe K, Jellesen MS, Jakobsen SS. Cytokine Profile in Patients with Aseptic Loosening of Total Hip Replacements and Its Relation to Metal Release and Metal Allergy. J Clin Med 2019; 8:jcm8081259. [PMID: 31434199 PMCID: PMC6723430 DOI: 10.3390/jcm8081259] [Citation(s) in RCA: 16] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/19/2019] [Revised: 08/06/2019] [Accepted: 08/09/2019] [Indexed: 12/13/2022] Open
Abstract
Metal release from total hip replacements (THRs) is associated with aseptic loosening (AL). It has been proposed that the underlying immunological response is caused by a delayed type IV hypersensitivity-like reaction to metals, i.e., metal allergy. The purpose of this study was to investigate the immunological response in patients with AL in relation to metal release and the prevalence of metal allergy. THR patients undergoing revision surgery due to AL or mechanical implant failures were included in the study along with a control group consisting of primary THR patients. Comprehensive cytokine analyses were performed on serum and periimplant tissue samples along with metal analysis using inductive coupled plasma mass spectrometry (ICP-MS). Patient patch testing was done with a series of metals related to orthopedic implant. A distinct cytokine profile was found in the periimplant tissue of patients with AL. Significantly increased levels of the proinflammatory cytokines IL-1β, IL-2, IL-8, IFN-γ and TNF-α, but also the anti-inflammatory IL-10 were detected. A general increase of metal concentrations in the periimplant tissue was observed in both revision groups, while Cr was significantly increased in patient serum with AL. No difference in the prevalence of metal sensitivity was established by patch testing. Increased levels of IL-1β, IL-8, and TNF-α point to an innate immune response. However, the presence of IL-2 and IFN-γ indicates additional involvement of T cell-mediated response in patients with AL, although this could not be detected by patch testing.
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Affiliation(s)
- Rune J Christiansen
- Department of Mechanical Engineering, Technical University of Denmark, DK-2800 Kgs. Lyngby, Denmark.
- Department of Immunology and Microbiology, University of Copenhagen, DK-2200 Copenhagen, Denmark.
| | - Henrik J Münch
- Institute of Clinical Medicine-Orthopedic Surgery, Aarhus University, DK-8000 Aarhus C, Denmark
| | - Charlotte M Bonefeld
- Department of Immunology and Microbiology, University of Copenhagen, DK-2200 Copenhagen, Denmark
| | - Jacob P Thyssen
- Institute of Clinical Medicine, Copenhagen University, Gentofte Hospital, DK-2900 Hellerup, Denmark
| | - Jens J Sloth
- National Food Institute, Research Group on Nanobio Science, Technical University of Denmark, DK-2860 Søborg, Denmark
| | - Carsten Geisler
- Department of Immunology and Microbiology, University of Copenhagen, DK-2200 Copenhagen, Denmark
| | - Kjeld Søballe
- Institute of Clinical Medicine-Orthopedic Surgery, Aarhus University, DK-8000 Aarhus C, Denmark
| | - Morten S Jellesen
- Department of Mechanical Engineering, Technical University of Denmark, DK-2800 Kgs. Lyngby, Denmark
| | - Stig S Jakobsen
- Institute of Clinical Medicine-Orthopedic Surgery, Aarhus University, DK-8000 Aarhus C, Denmark.
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6
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Hedberg YS, Žnidaršič M, Herting G, Milošev I, Odnevall Wallinder I. Mechanistic insight on the combined effect of albumin and hydrogen peroxide on surface oxide composition and extent of metal release from Ti6Al4V. J Biomed Mater Res B Appl Biomater 2018; 107:858-867. [PMID: 30102828 PMCID: PMC6586049 DOI: 10.1002/jbm.b.34182] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/12/2018] [Revised: 05/03/2018] [Accepted: 05/28/2018] [Indexed: 11/06/2022]
Abstract
The titanium-aluminium (6 wt%)-vanadium (4 wt%) (Ti6Al4V) alloy is widely used as an orthopedic and dental implant material due to its high corrosion resistance in such environments. The corrosion resistance is usually determined by means of electrochemical methods, which may not be able to detect other chemical surface reactions. Literature findings report a synergistic effect of the combination of the abundant protein albumin and hydrogen peroxide (H2 O2 ) on the extent of metal release and corrosion of Ti6Al4V. The objectives of this study were to gain further mechanistic insight on the interplay of H2 O2 and albumin on the metal release process of Ti6Al4V with special focus on (1) kinetics and (2) H2 O2 and albumin concentrations. This was accomplished mainly by metal release and surface oxide composition investigations, which confirmed the combined effect of H2 O2 and albumin on the metal release process, although not detectable by electrochemical open circuit potential measurements. A concentration of 30 mM H2 O2 induced substantial changes in the surface oxide characteristics, an oxide which became thicker and enriched in aluminum. Bovine serum albumin (BSA) seemed to be able to deplete this aluminum content from the outermost surface or at least to delay its surface enrichment. This effect increased with increased BSA concentration, and for time periods longer than 24 h. This study hence suggests that short-term (accelerated) corrosion resistance measurements are not sufficient to predict potential health effects of Ti6Al4V alloys since also chemical dissolution mechanisms play a large role for metal release, possibly in a synergistic way. © 2018 Wiley Periodicals, Inc. J Biomed Mater Res Part B: Appl Biomater 107B: 855-867, 2019.
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Affiliation(s)
- Yolanda S Hedberg
- Department of Chemistry, Division of Surface and Corrosion Science, KTH Royal Institute of Technology, Drottning Kristinas väg 51, SE-10044, Stockholm, Sweden
| | - Monika Žnidaršič
- Department of Chemistry, Division of Surface and Corrosion Science, KTH Royal Institute of Technology, Drottning Kristinas väg 51, SE-10044, Stockholm, Sweden.,Faculty of Chemistry and Chemical Technology, University of Ljubljana, Večna pot 113, SI-1000, Ljubljana, Slovenia
| | - Gunilla Herting
- Department of Chemistry, Division of Surface and Corrosion Science, KTH Royal Institute of Technology, Drottning Kristinas väg 51, SE-10044, Stockholm, Sweden
| | - Ingrid Milošev
- Department of Physical and Organic Chemistry, Jožef Stefan Institute, Jamova c. 39, SI-1000, Ljubljana, Slovenia
| | - Inger Odnevall Wallinder
- Department of Chemistry, Division of Surface and Corrosion Science, KTH Royal Institute of Technology, Drottning Kristinas väg 51, SE-10044, Stockholm, Sweden
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7
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Dubey N, Ellepola K, Decroix FED, Morin JLP, Castro Neto AH, Seneviratne CJ, Rosa V. Graphene onto medical grade titanium: an atom-thick multimodal coating that promotes osteoblast maturation and inhibits biofilm formation from distinct species. Nanotoxicology 2018; 12:274-289. [PMID: 29409364 DOI: 10.1080/17435390.2018.1434911] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The time needed for the osseointegration of titanium implants is deemed too long. Moreover, the bacterial colonization of their surfaces is a major cause of failure. Graphene can overcome these issues but its wet transfer onto substrates employs hazardous chemicals limiting the clinical applications. Alternatively, dry transfer technique has been developed, but the biological properties of this technique remain unexplored. Here, a dry transfer technique based on a hot-pressing method allowed to coat titanium substrates with high-quality graphene and coverage area >90% with a single transfer. The graphene-coated titanium is cytocompatible, did not induce cell membrane damage, induced human osteoblast maturation (gene and protein level), and increased the deposition of mineralized matrix compared to titanium alone. Moreover, graphene decreased the formation of biofilms from Streptococcus mutans, Enterococcus faecalis and even from whole saliva on titanium without killing the bacteria. These findings confirm that coating of titanium with graphene via a dry transfer technique is a promising strategy to improve osseointegration and prevent biofilm formation on implants and devices.
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Affiliation(s)
- Nileshkumar Dubey
- a Faculty of Dentistry , National University of Singapore , Singapore , Singapore
| | - Kassapa Ellepola
- a Faculty of Dentistry , National University of Singapore , Singapore , Singapore
| | - Fanny E D Decroix
- b Centre for Advanced 2D Materials and Graphene Research Centre , National University of Singapore , Singapore , Singapore
| | - Julien L P Morin
- b Centre for Advanced 2D Materials and Graphene Research Centre , National University of Singapore , Singapore , Singapore
| | - A H Castro Neto
- b Centre for Advanced 2D Materials and Graphene Research Centre , National University of Singapore , Singapore , Singapore
| | | | - Vinicius Rosa
- a Faculty of Dentistry , National University of Singapore , Singapore , Singapore.,b Centre for Advanced 2D Materials and Graphene Research Centre , National University of Singapore , Singapore , Singapore
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8
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Christensen TJ, Samant SA, Shin AY. Making Sense of Metal Allergy and Hypersensitivity to Metallic Implants in Relation to Hand Surgery. J Hand Surg Am 2017; 42:737-746. [PMID: 28709788 DOI: 10.1016/j.jhsa.2017.06.009] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2016] [Accepted: 06/12/2017] [Indexed: 02/02/2023]
Abstract
All metals implanted into a biological system undergo some degree of corrosion depending upon its composition. The electrochemical process of corrosion produces free metal ions, which may activate the host's immune system through a variety of mechanisms. Whereas dermal metal hypersensitivity is common, affecting 10% to 15% of the population, the immune reaction from implanted metals is much less common (< 0.1%), but has been associated with metal allergy and hypersensitivity producing a multitude of patient symptoms. Superficial symptoms may be mild to severe forms of dermatitis, urticaria, pruritus, and vasculitis, whereas deep sequelae include metallosis-related pseudotumor, implant loosening, and joint stiffness. Currently, there are clinical tests to evaluate patients for metal hypersensitivity, but there is little agreement regarding the ideal timing and clinical situation prompting the work-up of a patient for a metal allergy or hypersensitivity. An understanding of the epidemiology, etiology, basic science, diagnostic testing, and treatment of patients with suspected metal allergy, as it pertains to the current literature, will aid orthopedic and plastic surgeons of all subspecialties in the management of patients requiring metallic implants.
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Affiliation(s)
| | | | - Alexander Y Shin
- Department of Orthopedic Surgery, Division of Hand Surgery, Mayo Clinic, Rochester, MN.
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9
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Wawrzynski J, Gil JA, Goodman AD, Waryasz GR. Hypersensitivity to Orthopedic Implants: A Review of the Literature. Rheumatol Ther 2017; 4:45-56. [PMID: 28364382 PMCID: PMC5443731 DOI: 10.1007/s40744-017-0062-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 4.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/14/2016] [Indexed: 12/18/2022] Open
Abstract
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. As a result of the ineffectiveness of preoperative patch testing for predicting adverse outcomes, as well as the high cost of implementing such patch testing as standard procedure, most orthopedists and dermatologists agree that an alternative prosthesis should only be considered for patients with a history of allergy to a metal in the standard implant. In patients with a failed implant requiring revision surgery, hypersensitivity to an implant component should be considered in the differential diagnosis. Because a metal allergy to implant components is currently not commonly considered in the differential for joint failure in the orthopedic literature, there should be improved communication and collaboration between orthopedists and dermatologists when evaluating joint replacement patients with a presentation suggestive of allergy.
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Affiliation(s)
| | - Joseph A Gil
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA.
| | - Avi D Goodman
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
| | - Gregory R Waryasz
- Department of Orthopaedic Surgery, Warren Alpert Medical School, Brown University, Providence, RI, USA
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10
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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.
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11
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Biomaterial hypersensitivity: is it real? Supportive evidence and approach considerations for metal allergic patients following total knee arthroplasty. BIOMED RESEARCH INTERNATIONAL 2015; 2015:137287. [PMID: 25883940 PMCID: PMC4390183 DOI: 10.1155/2015/137287] [Citation(s) in RCA: 47] [Impact Index Per Article: 5.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Accepted: 09/19/2014] [Indexed: 12/20/2022]
Abstract
The prospect of biomaterial hypersensitivity developing in response to joint implant materials was first presented more than 30 years ago. Many studies have established probable causation between first-generation metal-on-metal hip implants and hypersensitivity reactions. In a limited patient population, implant failure may ultimately be related to metal hypersensitivity. The examination of hypersensitivity reactions in current-generation metal-on-metal knee implants is comparatively limited. The purpose of this study is to summarize all available literature regarding biomaterial hypersensitivity after total knee arthroplasty, elucidate overall trends about this topic in the current literature, and provide a foundation for clinical approach considerations when biomaterial hypersensitivity is suspected.
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12
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Okazaki Y, Gotoh E. Metal ion effects on different types of cell line, metal ion incorporation into L929 and MC3T3-E1 cells, and activation of macrophage-like J774.1 cells. MATERIALS SCIENCE & ENGINEERING. C, MATERIALS FOR BIOLOGICAL APPLICATIONS 2013; 33:1993-2001. [PMID: 23498224 DOI: 10.1016/j.msec.2013.01.015] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/10/2012] [Revised: 11/27/2012] [Accepted: 01/10/2013] [Indexed: 10/27/2022]
Abstract
V ions showed high cytotoxicity for mouse fibroblast L929, osteoblastic MC3T3-E1, and macrophage-like J774.1 cells compared with Pb, Cu, Ni, Co, Zn, and Mo ions. The quantities of metal ions incorporated into the L929 and MC3T3-E1 cells increased with increasing metal concentration in the medium, depending on the metal ion type. In particular, the quantities of V incorporated into the cells were markedly higher than those of other metals. It was suggested that the cytotoxicity of a metal ion changes with the quantity of the metal ion incorporated into cells. It was also considered that V ions are incorporated into cells through xanthine derived from fetal bovine serum by high-performance liquid chromatography (HPLC). The strong interaction of Co, Ni and Mo with amino acids was analyzed by HPLC. The rate of increase of nitric oxide (NO) concentration released with the activation of the mouse macrophage-like J774.1 cells increased at a concentration of V ions ten times lower than that of Ni ions. The release of the cytokine tumor necrosis factor-α (TNF-α) from the J774.1 cells started at approximately 0.5 ppm V; interleukin-6 (IL-6) and transforming growth factor-β (TGF-β) showed a marked increase in the rate of increase at more than 1 ppm V. No increase in the concentration of IL-1α, IL-8, IL-15 or granulocyte macrophage-colony stimulating factor (GM-CSF) was observed for V and Ni ions.
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Affiliation(s)
- Yoshimitsu Okazaki
- National Institute of Advanced Industrial Science and Technology, 1-1-1, Higashi, Tsukuba-shi, Ibaraki 305-8566, Japan.
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13
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Allergy to orthopedic metal implants — A prospective study. Int J Occup Med Environ Health 2012; 25:463-9. [DOI: 10.2478/s13382-012-0029-3] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/02/2012] [Accepted: 04/05/2012] [Indexed: 11/20/2022] Open
Abstract
Abstract
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14
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Lésion eczématiforme chronique du sein après mise en place d’un clip chirurgical. ACTA ACUST UNITED AC 2011; 40:174-7. [DOI: 10.1016/j.jgyn.2010.07.010] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2009] [Revised: 07/15/2010] [Accepted: 07/28/2010] [Indexed: 11/19/2022]
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15
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16
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Geier J, Lessmann H, Becker D, Thomas P. Allergologische Diagnostik bei Verdacht auf Implantatunverträglichkeit: Hinweise für die Praxis. Hautarzt 2008; 59:594-7. [DOI: 10.1007/s00105-008-1587-y] [Citation(s) in RCA: 28] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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17
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Lamprakis AA, Fortis AP, Dimas A. Rejection reaction to stabilizing bolts after ACL reconstruction: a case report. Knee Surg Sports Traumatol Arthrosc 2008; 16:19-23. [PMID: 17661015 DOI: 10.1007/s00167-007-0388-7] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/02/2007] [Accepted: 06/28/2007] [Indexed: 11/26/2022]
Abstract
A case of an adverse reaction to the stabilizing bolts after an ACL reconstruction is presented. A 21-year-old patient had an ACL reconstruction using the Mark II system. Six months post op, he presented to clinic having formed a pretibial swelling with serous discharge. There was mild tenderness over the femoral scar. Successive cultures of the tibial cyst effluent showed no microorganism growth and laboratory tests were normal. One year post op, symptoms and swelling persisted. X-rays showed periosteal reaction around the femoral bolt and resorption with widening of the distal tibial tunnel. An adverse reaction to the bolts was suggested as the possible cause. Surgical exploration was then performed. During the operation, free fluid evacuated from the femoral site and the tibial cyst was completely excised. All specimens were sent for culture, which were proven negative. Tibial and femoral bolts were both removed and no communication of the osseous tunnels to the joint was found. An arthroscopy was performed at the same time which showed degeneration of the ACL autograft, but an otherwise normal joint. Eighteen months later, the patient was symptom free and all inflammation indices still within the normal range.
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Affiliation(s)
- Andreas A Lamprakis
- 2nd Orthopaedic Department, General Panarcadic Hospital of Tripolis, Tripolis, Greece. Lamprakis,
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De Medeiros LM, Fransway AF, Taylor JS, Wyman M, Janes J, Fowler JF, Rietschel RL. Complementary and alternative remedies: an additional source of potential systemic nickel exposure. Contact Dermatitis 2007; 58:97-100. [DOI: 10.1111/j.1600-0536.2007.01272.x] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
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