Allergy to orthopedic metal implants — A prospective study
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Evaluation of the allergenic properties of the metal knee or hip joint implants 24 months post surgery and assessment of the relation between allergy to metals and metal implants failure.
Materials and Methods
The study was conducted in two stages. Stage I (pre-implantation) — 60 patients scheduled for arthroplasty surgery. Personal interview, dermatological examination and patch testing with 0.5% potassium dichromate, 1.0% cobalt chloride, 5.0% nickel sulfate, 2.0% copper sulfate, 2.0% palladium chloride, 100% aluminum, 1% vanadium chloride, 5% vanadium, 10% titanium oxide, 5% molybdenum and 1% ammonium molybdate tetrahydrate were performed. Stage II (post-surgery) — 48 subjects participated in the same procedures as those conducted in Stage I.
Stage I — symptoms of “metal dermatitis” were found in 21.7% of the subjects: 27.9% of the females, 5.9% of the males. Positive patch test results were found in 21.7% of the participants, namely to: nickel (20.0%); palladium (13.3%); cobalt (10.0%); and chromium (5.9%). The allergy to metals was confirmed by patch testing in 84.6% of the subjects with a history of metal dermatitis. Stage II — 10.4% of the participants complained about implant intolerance, 4.2% of the examined persons reported skin lesions. Contact allergy to metals was found in 25.0% of the patients: nickel 20.8%, palladium 10.4%, cobalt 16.7%, chromium 8.3%, vanadium 2.1% Positive post-surgery patch tests results were observed in 10.4% of the patients. The statistical analysis of the pre- and post-surgery patch tests results showed that chromium and cobalt can be allergenic in implants.
Metal orthopedic implants may be the primary cause of allergies. that may lead to implant failure. Patch tests screening should be obligatory prior to providing implants to patients reporting symptoms of metal dermatitis. People with confirmed allergies to metals should be provided with implants free from allergenic metals.
- Quintana JM, Arostequi I, Escobar A, Azkarate J, Goenaga I, Lafuente I. Prevalence of knee and hip osteoarthritis and appropriateness of joint replacement in older population. Arch Intern Med 2008;168:1576–1584. CrossRef
- Basko-Plluska JL, Thyssen JP, Schalock PC. Cutaneous and systemic hypersensitivity reactions to metallic implants. Dermatitis 2011;22:65–79.
- 316/316L stainless steel. Product data sheet [cited 2011 December 15. Available from URL: http:/www.aksteel.com/PDF/markets_products/stainless/austenitic/316_316L_Data_Sheet.pdf.
- Disegi JA, Eschbach L. Stainless steel in bone surgery. Int J Care Injured 2000;31(Suppl 4):2–6.
- Holzwarth U, Thomas P, Kachler W, Göske J, Schnuch A. Metallurgical differentiation of cobalt-chromium alloys for implants. Orthopade 2005;34:1046–1051. CrossRef
- Gawkrodger DJ. Metal sensitivities and orthopaedic implants revised: The potential for metal allergy with the new metal-on-metal joint prostheses. Br J Dermatol 2003;148:1089–1093. CrossRef
- Simpson JM, Villar RN. Hip resurfacing. Br Med J 2010;341:3459. CrossRef
- Dietrich K-A, Mazoochian F, Summer B, Reinert M, Ruzicka T, Thomas P. Intolerance reactions to knee arthroplasty in patients with nickel/cobalt allergy and disappearance of symptoms after revision surgery with titanium-based endoprostheses. JDDG 2009;7:410–413.
- Niki Y, Matsumoto H, Otani T, Yatabe T, Kondo M, Yoshimine F, et al. Screening for symptomatic metal sensitivity: A prospective study of 92 patients undergoing total knee arthroplasty. Biomaterials 2006;26:1019–1026. CrossRef
- Thyssen JP, Jacobsen SS, Engkilde K, Johansen JD, Søballe K, Menné T. The association between metal allergy, total hip arthroplasty and revision. Acta Orthop 2009;80:646–652. CrossRef
- Gawkrodger DJ. Nickel sensitivity and the implantation of orthopaedic prostheses. Contact Dermatitis 1993;28:257–259. CrossRef
- Thyssen JP, Menné T, Schalock PC, Taylor JS, Maibach HI. Pragmatic approach to the clinical work-up of patients with putative allergic disease to metallic orthopaedic implants before and after surgery. Br J Dermatol 2011;164:473–478.
- Bruze M. Thoughts on implants and contact allergy. Arch Dermatol 2008;144:1042–1044. CrossRef
- Rydin S. Investigation of the content of Cr(VI) and Cr(III) in leather products on the Danish market. Survey of Chemical Substances in Consumer Products. Survey no. 3. Danish Environmental Protection Agency, Danish Ministry of the Environment; 2002.
- Wahlberg JE. Patch testing. In: Rycroft RJG, Menné T, Frosch PJ, Lepoittevin JP, editors. Textbook of contact dermatitis. 3rd edition. Berlin: Springer; 2001. p. 439–468.
- Carlsson AS, Magnusson B, Möller H. Metal sensitivity in patients with metal-to metal total hip arthroplasties. Acta Orthop Scand 1980;51:57–62. CrossRef
- Frigerio E, Piagatto PD, Guzzi G, Altomare G. Metal sensitivity in patients with orthopaedic implants: A prospective study. Contact Dermatitis 2011;64:273–279. CrossRef
- Waterman AH, Schrik JJ. Allergy in hip arthroplasty. Contact Dermatitis 1985;13:294–301. CrossRef
- Carlsson A, Möller H. Implantation of orthopaedic device in patients with metal allergy. Acta Derm Venereol 1989;69:62–66.
- Hallab N, Merrit K, Jacobs JJ. Metal sensitivity in patients with orthopaedic implants. J Bone Joint Surg Am 2001;83:428–436. CrossRef
- Kręcisz B, Kieć-Świerczyńska M, Bąkowicz-Mitura K. Allergy to metals as a cause of orthopedic implant failure. Int J Occup Med Environ Health 2006;19:178–180. CrossRef
- Schalock PC, Menné T, Johansen JD, Taylor JS, Maibach HI, Lindén C, et al. Hypersensitivity reactions to metallic implants — diagnostic algorithm and suggested patch test series for clinical use. Contact Dermatitis 2011;66:4–19. CrossRef
- Kieffer M. Nickel sensitivity: relationship between history and patch test reactions. Contact Dermatitis 1979;5:398–401. CrossRef
- Thyssen JP, Linneberg A, Menné T, Johansen JD. The epidemiology of contact allergy in the general population — prevalence and main findings. Contact Dermatitis 2007;57:287–299. CrossRef
- Reed KB, Davis MD, Nakamura K, Hanson L, Richardson DM. Retrospective evaluation of patch testing before or after metal device implantation. Arch Dermatol 2008;144:999–1007. CrossRef
- Allergy to orthopedic metal implants — A prospective study
International Journal of Occupational Medicine and Environmental Health
Volume 25, Issue 4 , pp 463-469
- Cover Date
- Print ISSN
- Online ISSN
- SP Versita
- Additional Links
- Orthopedic implants
- Allergy to metals
- Contact dermatitis
- Patch tests
- Author Affiliations
- 1. Center of Occupational Allergy and Environmental Health, Nofer Institute of Occupational Medicine, Łódź, Poland
- 2. Center of Occupational Allergy and Environmental Health, Nofer Institute of Occupational Medicine, św. Teresy 8, 91-348, Łódź, Poland