An interleukin-1 polymorphism additionally intensified by atopy as prognostic factor for aseptic non-mechanical complications in metal knee and hip arthroplasty

Background

In contrast to infection or mechanical issues joint replacement failure following inflammatory adverse reactions is poorly understood.

Objective

To assess the association of IL-1β polymorphisms and history of allergy with aseptic non-mechanical complications following arthroplasty.

Methods

In 102 patients with aseptic non-mechanically caused symptomatic knee or hip arthroplasty (SA) and 93 patients with asymptomatic arthroplasty (AA) questionnaire-based history, patch test with at least standard series, lymphocyte transformation test (LTT) with nickel, cobalt and chromium and interleukin-1 polymorphism analysis were done. Three polymorphisms of the IL1B gene [IL-1b -3954 (rs1143634), IL-1b -511 (rs16944) and IL-1b -31 (rs1143627)] and one polymorphism of the IL1RN gene [IL1RN intron 2, variable number of tandem repeats, VNTR (rs2234663)] were assessed by PCR and gel electrophoresis.

Results

We found no significant difference in smoking history and atopy but 25% versus 10% of self-reported metal allergy in SA versus AA; the patch test (respective, LTT) for metal sensitivity was more often positive in SA patients. The allele 498 bp of the IL1RN polymorphism occurred significantly more often in the SA group (37% versus 11%; p < 0.0001). Upon additional presence of atopy, the difference was even greater (60% vs 10%) (p < 0.000001). There was no association of IL-1 polymorphisms with metal allergy.

Conclusion

The IL1RN VNTR allele 498 bp was strongly associated with SA. In patients with a history of atopy, presence of the IL1RN VNTR allele 498 bp led to a four-fold higher SA prevalence compared to patients without this allele.

[Characteristics of 200 patients with suspected implant allergy compared to 100 symptom-free arthroplasty patients]

BACKGROUND

Data on implant allergies are incomplete; therefore, we compared the data on allergy history, patch test (PT) and lymphocyte transformation test (LTT) results in a patient series from the Munich implant allergy outpatient department with symptom-free arthroplasty patients.

PATIENTS AND METHODS

In this study 200 arthroplasty patients with complaints involving the prosthesis (130 female, 187 knee and 13 hip prostheses) and in parallel 100 symptom-free patients (75 female, 47 knee and 53 hip prostheses) were investigated. A questionnaire-aided history including implant type, cementing, intolerance of dental materials, atopy, cutaneous metal intolerance (CMI) and PT, including a standard series with Ni, Co, Cr, seven bone cement components, including gentamicin and benzoyl peroxide and LTT for Ni, Co and Cr.

RESULTS

In the knee arthroplasty patients with complaints 9.1% showed dental material intolerance, 23.5% atopy, 25.7% CMI, 18.2% metal allergies, 7.4% gentamicin allergy and 27.8% positive metal LTT (mostly to Ni). In symptom-free patients 0% showed dental material intolerance, 19.1% atopy, 12.8% CMI, 12.8% metal allergy, 0% gentamicin allergy and 17% positive metal LTT.

CONCLUSIONS

Characteristics of the patients with complaints were increased intolerance of dental materials, higher rates of atopy, CMI, metal and gentamicin allergy and LTT reactivity.

[Age and migration--an overview]

In the course of demographic change, the number of elderly migrants increases, and the population of elderly people in Germany becomes more varied-facts that have to be taken into account more intensely when it comes to planning services for elderly people in the future. The need for action is intensified by the fact that elderly migrants are still worse off than natives of the same age in many areas of life (e. g. income, health, etc.). At the same time, elderly migrants cannot automatically be regarded as helpless or isolated because of their solid family help networks.Meanwhile, on political and social levels, approaches have been developed to open services and institutions for the special needs of minority ethnic elders. Furthermore, offers have been established by the creation of ethnic-specific emphases that focus on the life style and the everyday life of the target group. In spite of all these efforts, the whole range of care services for the population of elderly migrants is still regarded as insufficient by experts. Therefore, especially in the fields of networking, cooperation and controlling of the people involved, information transfer, and training measures that aim at better preparing the provider of care services for elderly people are highly recommended in order to meet the increasing needs of help and care of older migrants more precisely.