Published 4 issues per year
ISSN Print: 1050-6934
ISSN Online: 1940-4379
Indexed in
Metal Sensitivities Among TJA Patients with Post-Operative Pain: Indications for Multi-Metal LTT Testing
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.
-
Thomsen M., Krenn V., Thomas P., Adverse Reaktionen gegenüber orthopädisch-chirurgischen Metallimplantaten nach Kniegelenkersatz, Der Hautarzt, 67, 5, 2016. Crossref
-
Thomsen M., Thomas P., Verträglichkeit und Allergie von Osteosynthesematerialien, Der Unfallchirurg, 120, 2, 2017. Crossref
-
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
-
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
-
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
-
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
-
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
-
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
-
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
-
Whiteside Leo A., Clinical Results of Revision TKA in Patients With Presumed Metal and Cement Allergy, The Journal of Arthroplasty, 37, 6, 2022. Crossref