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Journal of Long-Term Effects of Medical Implants

Published 4 issues per year

ISSN Print: 1050-6934

ISSN Online: 1940-4379

SJR: 0.184 SNIP: 0.485 CiteScore™:: 1.1 H-Index: 39

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Metal Sensitivities Among TJA Patients with Post-Operative Pain: Indications for Multi-Metal LTT Testing

Volume 24, Issue 1, 2014, pp. 37-44
DOI: 10.1615/JLongTermEffMedImplants.2014010261
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ABSTRACT

Metal sensitivity testing is generally the diagnosis method of last resort for aseptic painful implants with elevated inflammatory responses. However, the relationship between implant-related pain and implant-debris-related metal sensitization remains incompletely understood. Although a sensitivity to nickel alone has been used as a general measure of metal allergy, it may lack the specificity to correlate sensitivity to specific implant metals and thus to select a biologically appropriate implant material. In this retrospective study, we report the incidence of pain and nickel sensitivity in patients with total joint arthroplasties (TJAs) referred for metal sensitivity testing (n=2018). We also correlated the degree of nickel hypersensitivity to implant pain levels (none, mild, moderate, and high, using a scale of 0−10) and the incidence of sensitivity to alternative implant metals in highly nickel-reactive subjects. Most patients (>79%) reported pain levels that were moderate to high regardless of implant age, whereas patients with severely painful TJAs had a statistically greater incidence of nickel sensitivity over the short-term post-operative period (≤4 years). Patients with moderate pain scores (4−7) and high pain scores (≥8) also exhibited significantly higher sensitivity to nickel compared to patients with no pain and no implant (controls) (p<0.05). Highly nickel-sensitive subjects (SI>8) also showed incidences of sensitization to alternative materials such as cobalt, chromium, or molybdenum (57%) or aluminum or vanadium alloy (52%). These data suggest that painful TJAs caused by metal sensitivity more likely occur relatively early in the post-operative period (≤4 years). The incidences of sensitivity to alternative implant metals in only a subset of nickel-reactive patients highlights the importance of testing for sensitization to all potential revision implant materials.

CITED BY
  1. Thomsen M., Krenn V., Thomas P., Adverse Reaktionen gegenüber orthopädisch-chirurgischen Metallimplantaten nach Kniegelenkersatz, Der Hautarzt, 67, 5, 2016. Crossref

  2. Thomsen M., Thomas P., Verträglichkeit und Allergie von Osteosynthesematerialien, Der Unfallchirurg, 120, 2, 2017. Crossref

  3. Caicedo Marco S., Solver Edward, Coleman Latasha, Jacobs Joshua J., Hallab Nadim J., Females with Unexplained Joint Pain Following Total Joint Arthroplasty Exhibit a Higher Rate and Severity of Hypersensitivity to Implant Metals Compared with Males, Journal of Bone and Joint Surgery, 99, 8, 2017. Crossref

  4. Craig Richard, Vlychou Marianna, McCarthy Catherine L., Gibbons Christopher L. M. H., Athanasou N. A., Metal wear-induced pseudotumour following an endoprosthetic knee replacement for Ewing sarcoma, Skeletal Radiology, 46, 7, 2017. Crossref

  5. Lionberger David R., Samorajski Justin, Wilson Charlie D., Rivera Andreana, What role does metal allergy sensitization play in total knee arthroplasty revision?, Journal of Experimental Orthopaedics, 5, 1, 2018. Crossref

  6. Malahias Michael-Alexander, Bauer Thomas W., Gu Alex, Nocon Allina A., De Martino Ivan, Sculco Peter K., Questioning the Clinical Relevance of Positive Post-implantation Allergy Testing for Metal Hypersensitivity in Total Knee Arthroplasty: A Didactic Case Report, HSS Journal ®, 16, S2, 2020. Crossref

  7. Maale Gerhard, Mohammadi Daniel, Kennard Nicole, Srinivasaraghavan Aniruth, Early Failures of Total Knee Patients with Nickel Allergies Secondary to Carbon Fiber Debris, The Open Orthopaedics Journal, 14, 1, 2020. Crossref

  8. Malahias Michael-Alexander, Bauer Thomas W., Manolopoulos Philip P., Sculco Peter K., Westrich Geoffrey H., Allergy Testing Has No Correlation with Intraoperative Histopathology from Revision Total Knee Arthroplasty for Implant-Related Metal Allergy, The Journal of Knee Surgery, 2021. Crossref

  9. Eftekhary Nima, Shepard Nicholas, Wiznia Daniel, Iorio Richard, Long William John, Vigdorchik Jonathan, Metal Hypersensitivity in Total Joint Arthroplasty, JBJS Reviews, 6, 12, 2018. Crossref

  10. Whiteside Leo A., Clinical Results of Revision TKA in Patients With Presumed Metal and Cement Allergy, The Journal of Arthroplasty, 37, 6, 2022. Crossref

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