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20 Allergy and Hypersensitivity to Implant Materials

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The Unhappy Total Knee Replacement

Abstract

Several metal alloys are in use for joint replacement [12]. The alloys used in these materials require optimal stability and endurance over prolonged time periods; on the other hand, they should present optimal biocompatibility and allow connection with the bone without inducing either toxic reactions or activation of the innate or the adaptive immune system [13].

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References

  1. Looney RJ, Schwarz E, Boyd A, O’Keefe R. Periprosthetic osteolysis: an immunologist’s update. Curr Opin Rheumatol. 2006;18(1):80–7.

    Article  PubMed  Google Scholar 

  2. Thomas P, Schuh A, Ring J, Thomsen M. Orthopädisch-chirurgische Implantate und Allergien. Orthopade. 2008;1:1–14.

    Google Scholar 

  3. 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;164:473–8.

    CAS  PubMed  Google Scholar 

  4. Raison-Peyron N. Implants et prothèses (hors dentisterie) et allergie aux métaux. Rev Fr Allergol. 2010;50:S23–8.

    Article  Google Scholar 

  5. Uter W, Aberer W, Armario-Hita JC, Fernandez-Vozmediano JM, Ayala F, Balato A, et al. Current patch test results with the European baseline series and extensions to it from the ‘European Surveillance System on Contact Allergy’ network, 2007–2008. Contact Dermatitis. 2012;67(1):9–19.

    Article  CAS  PubMed  Google Scholar 

  6. Thyssen JP, Menné T. Metal allergy – a review on exposures, penetration, genetics, prevalence, and clinical implications. Chem Res Toxicol. 2010;23:309–18.

    Article  CAS  PubMed  Google Scholar 

  7. Federmann M, Morell B, Graetz G, Wyss M, Elsner P, von Thiessen R, et al. Hypersensitivity to molybdenum as a possible trigger of ANA-negative systemic lupus erythematosus. Ann Rheum Dis. 1994;53(6):403–5.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  8. Bircher A, Friederich NF, Seelig W, Scherer K. Allergic complications from orthopaedic joint implants: the role of delayed hypersensitivity to benzoyl peroxide in bone cement. Contact Dermatitis. 2012;66(1):20–6.

    Article  CAS  PubMed  Google Scholar 

  9. Cadosch D, Chan E, Gautschi O, Filgueira L. Metal is not inert: role of metal ions released by biocorrosion in aseptic loosening–current concepts. J Biomed Mater Res A. 2009;91(4):1252–62.

    Article  PubMed  Google Scholar 

  10. Thomas P, Thomas M, Summer B, Dietrich K, Zauzig M, Steinhauser E, et al. Impaired wound-healing, local eczema, and chronic inflammation following titanium osteosynthesis in a nickel and cobalt-allergic patient. J Bone Joint Surg Am. 2011;93(11):e61, 1–5.

    Article  PubMed  Google Scholar 

  11. Summer B, Paul C, Mazoochian F, Rau C, Thomsen M, Banke I, et al. Nickel (Ni) allergic patients with complications to Ni containing joint replacement show preferential IL-17 type reactivity to Ni. Contact Dermatitis. 2010;63:15–22.

    Article  CAS  PubMed  Google Scholar 

  12. Schuh A, Thomas P, Kachler W, Göske J, Wagner L, Holzwarth U, et al. Das Allergiepotenzial von Implantatwerkstoffen auf Titanbasis. Orthopade. 2005;34:327–33.

    Article  CAS  PubMed  Google Scholar 

  13. Tengvall P, Lundstrom I. Physio-chemical considerations of titanium as a biomaterial. Clin Mater. 1992;9:115–34.

    Article  CAS  PubMed  Google Scholar 

  14. Flint GN. A metallurgical approach to metal contact dermatitis. Contact Dermatitis. 1998;39(5):213–21.

    Article  CAS  PubMed  Google Scholar 

  15. Cadosch D, Chan E, Gautschi OP, Filgueira L. Bio-corrosion of stainless steel by osteoclasts – in vitro evidence. J Orthop Res. 2009;27:841–6.

    Article  CAS  PubMed  Google Scholar 

  16. Singh R, Dahotre NB. Corrosion degradation and prevention by surface modification of biometallic materials. J Mater Sci Mater Med. 2007;18:725–51.

    Article  CAS  PubMed  Google Scholar 

  17. Over H, Seitsonen AP. Surface chemistry. Oxidation of metal surfaces. Science. 2002;297(5589):2003–5.

    Article  CAS  PubMed  Google Scholar 

  18. Basko-Plluska JL, Thyssen JP, Schalock PC. Cutaneous and systemic hypersensitivity reactions to metallic implants. Dermatitis. 2011;22(2):65–79.

    PubMed  Google Scholar 

  19. Disegi JA, Wyss H. Implant materials for fracture fixation: a clinical perspective. Orthopedics. 1989;12:75–9.

    CAS  PubMed  Google Scholar 

  20. Muris J, Kleverlaan CJ, Rustemeyer T, von Blomberg ME, van Hoogstraten IMW, Feilzer AJ, et al. Sodium tetrachloropalladate for diagnosing palladium sensitization. Contact Dermatitis. 2012;67(2):94–100.

    Article  CAS  PubMed  Google Scholar 

  21. Treudler R, Simon J. Benzoyl peroxide: is it a relevant bone cement allergen in patients with orthopaedic implants? Contact Dermatitis. 2007;57(3):177–80.

    Article  CAS  PubMed  Google Scholar 

  22. Netterlid E, Hindsén M, Siemund I, Björk J, Werner S, Jacobsson H, et al. Does allergen-specific immunotherapy induce contact allergy to aluminium? Acta Derm Venereol. 2013;93(1):50–6.

    CAS  PubMed  Google Scholar 

  23. Stieger P, Bircher AJ. Sensibilisation aux métaux rarement impliqués dans l’allergie de contact. In: Le Coz C, editor. Progrès en Dermato-Allergologie – Strasbourg 2010. Montrouge: John Libbey Eurotext Ltd.; 2010. p. 165–92.

    Google Scholar 

  24. Yang W, Shaodong D. Structural basis of metal hypersensitivity. Immunol Res. 2013;55(1–3):83–90.

    Google Scholar 

  25. Gamerdinger K, Moulon C, Karp D, Van Bergen J, Koning F, Wild D, et al. A new type of metal recognition by human T cells: contact residues for peptide-independent bridging of T cell receptor and major histocompatibility complex by nickel. J Exp Med. 2003;197(10):1345–53.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  26. Schmidt M, Raghavan B, Muller V, Vogl T, Fejer G, Tchaptchet S, et al. Crucial role for human Toll-like receptor 4 in the development of contact allergy to nickel. Nat Immunol. 2010;11(9):814–9.

    Article  CAS  PubMed  Google Scholar 

  27. Weltzien H. Lessons from nickel hypersensitivity: structural findings. In: Pichler WJ, editor. Drug hypersensitivity. Basel: Karger; 2007. p. 47–54.

    Chapter  Google Scholar 

  28. Dorr LD, Bloebaum R, Emmanual J, Meldrum R. Histologic, biochemical, and ion analysis of tissue and fluids retrieved during total hip arthroplasty. Clin Orthop Relat Res. 1990;261:82–95.

    PubMed  Google Scholar 

  29. Jacobs JJ, Skipor AK, Patterson LM, Hallab NJ, Paprosky WG, Black J, et al. Metal release in patients who have had a primary total hip arthroplasty. A prospective, controlled, longitudinal study. J Bone Joint Surg Am. 1998;80:1447–58.

    CAS  PubMed  Google Scholar 

  30. Urban RM, Jacobs JJ, Tomlinson MJ, Gavrilovic J, Black J, Peoc’h M. Dissemination of wear particles to the liver, spleen, and abdominal lymph nodes of patients with hip or knee replacement. J Bone Joint Surg Am. 2000;82:457–76.

    Article  CAS  PubMed  Google Scholar 

  31. Lalor PA, Revell PA, Gray AB, Wright S, Railton GT, Freeman MA. Sensitivity to titanium. A cause of implant failure? J Bone Joint Surg Br. 1991;73(1):25–8.

    CAS  PubMed  Google Scholar 

  32. Steinemann SG. Metal implants and surface reactions. Injury. 1996;(Suppl 3):SC16–22.

    Google Scholar 

  33. Yan Y, Neville A, Dowson D. Understanding the role of corrosion in the degradation of metal-on-metal implants. Proc Inst Mech Eng H. 2006;220:173–81.

    Article  CAS  PubMed  Google Scholar 

  34. Williams RL, Brown SA, Merritt K. Electrochemical studies on the influence of proteins on the corrosion of implant alloys. Biomaterials. 1988;9:181–6.

    Article  CAS  PubMed  Google Scholar 

  35. Khan MA, Williams RL, Williams DF. Conjoint corrosion and wear in titanium alloys. Biomaterials. 1999;20:765–72.

    Article  CAS  PubMed  Google Scholar 

  36. Contu F, Elsener B, Böhni H. Electrochemical behavior of CoCrMo alloy in the active state in acidic and alkaline buffered solution. J Electrochem Soc. 2003;150:B419–24.

    Article  CAS  Google Scholar 

  37. Haddad FS, Thakrar RR, Hart AJ, Skinner JA, Nargol AVF, Nolan JF, et al. Metal-on-metal bearings: the evidence so far. J Bone Joint Surg Br. 2011;93(5):572–9.

    Article  CAS  PubMed  Google Scholar 

  38. Hart AJ, Skinner JA, Winship P, Faria N, Kulinskaya E, Webster D, et al. Circulating levels of cobalt and chromium from metal-on-metal hip replacement are associated with CD8+ T-cell lymphopenia. J Bone Joint Surg Br. 2009;91(6):835–42.

    Article  CAS  PubMed  Google Scholar 

  39. Bruze M. Thoughts on implants and contact allergy. Arch Dermatol. 2008;144(8):1042–4.

    Article  PubMed  Google Scholar 

  40. Leis Dosil VM, Cabeza Martinez R, Suarez Fernandez RM, Lazaro Ochaita P. Allergic contact dermatitis due to manganese in an aluminium alloy. Contact Dermatitis. 2006;54(1):67–8.

    Article  PubMed  Google Scholar 

  41. Reed K, Davis MDP, Nakamura K, Hanson L, Richardson D. Retrospective evaluation of patch testing before or after metal device implantation. Arch Dermatol. 2008;144(8):999–1007.

    Article  PubMed  Google Scholar 

  42. Eben R, Dietrich K-A, Nerz C, Schneider S, Schuh A, Banke IJ, et al. Kontaktallergieraten gegen Metalle und Knochenzementbestandteile bei Patienten mit Endoprothesenunverträglichkeit. Dtsch Med Wochenschr. 2010;135(28–29):1418–22.

    Article  CAS  PubMed  Google Scholar 

  43. Walters GI, Moore VC, Robertson AS, Burge CBSG, Vellore A-D, Burge PS. An outbreak of occupational asthma due to chromium and cobalt. Occup Med (Lond). 2012;62(7):533–40.

    Article  CAS  Google Scholar 

  44. Hines SE, Pacheco K, Maier LA. The role of lymphocyte proliferation tests in assessing occupational sensitization and disease. Curr Opin Allergy Clin Immunol. 2012;12(2):102–10.

    Article  PubMed  Google Scholar 

  45. Thomas P, Braathen LR, Dörig M, Auböck J, Nestle F, Werfel T, et al. Increased metal allergy in patients with failed metal-on-metal hip arthroplasty and peri-implant T-lymphocytic inflammation. Allergy. 2009;64(8):1157–65.

    Article  CAS  PubMed  Google Scholar 

  46. Frigerio E, Pigatto PD, Guzzi G, Altomare G. Metal sensitivity in patients with orthopaedic implants: a prospective study. Contact Dermatitis. 2011;64(5):273–9.

    Article  CAS  PubMed  Google Scholar 

  47. Hallab N. Lymphocyte transformation testing for quantifying metal-implant-related hypersensitivity responses. Dermatitis. 2004;15(2):82–90.

    Article  PubMed  Google Scholar 

  48. Muris J, Kleverlaan CJ, Feilzer AJ, Valentine-Thon E. Reactivity to sodium tetrachloropalladate (Na2[PdCl4]) compared to PdCl2 and NiCl2 in lymphocyte proliferation tests. Allergy. 2009;64(8):1152–6.

    Article  CAS  PubMed  Google Scholar 

  49. Gil F, Hernández AF, Márquez C, Femia P, Olmedo P, López-Guarnido O, et al. Biomonitorization of cadmium, chromium, manganese, nickel and lead in whole blood, urine, axillary hair and saliva in an occupationally exposed population. Sci Total Environ. 2011;409(6):1172–80.

    Article  CAS  PubMed  Google Scholar 

  50. Hallab N, Merritt K, Jacobs JJ. Metal sensitivity in patients with orthopaedic implants. J Bone Joint Surg Am. 2001;83-A(3):428–36.

    CAS  PubMed  Google Scholar 

  51. Thyssen JP, Jakobsen SS, Engkilde K, Johansen JD, Søballe K, Menné T. The association between metal allergy, total hip arthroplasty, and revision. Acta Orthop. 2009;80(6):646–52.

    Article  PubMed Central  PubMed  Google Scholar 

  52. Milavec-Puretić V, Orlić D, Marušić A. Sensitivity to metals in 40 patients with failed hip endoprosthesis. Arch Orthop Trauma Surg. 1998;117(6):383–6.

    Article  PubMed  Google Scholar 

  53. Cancilleri F, De Giorgis P, Verdoia C, Parrini L, Lodi A, Crosti C. Allergy to components of total hip arthroplasty before and after surgery. Ital J Orthop Traumatol. 1992;18(3):407–10.

    CAS  PubMed  Google Scholar 

  54. Granchi D, Cenni E, Trisolino G, Giunti A, Baldini N. Sensitivity to implant materials in patients undergoing total hip replacement. J Biomed Mater Res B Appl Biomater. 2006;77B(2):257–64.

    Article  CAS  Google Scholar 

  55. Schuh A, Lange-Riess D, Thomas P, Holzswarth U, Bader R, Hönle W. Der Gehalt von “allergisierenden” Bestandteilen in Implantat-Werkstoffen aus Titan. Orthop Praxis. 2009;46(5):232–8.

    Google Scholar 

  56. Bircher AJ. Patch tests with beryllium salts. Contact Dermatitis. 2011;64:363–4.

    Article  PubMed  Google Scholar 

  57. Ockenfels H-M, Uter W, Lessmann H, Schnuch A, Geier J. Patch testing with benzoyl peroxide: reaction profile and interpretation of positive patch test reactions. Contact Dermatitis. 2009;61(4):209–16.

    Article  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Department of Dermatology, Allergy Unit, University Hospital, Petersgraben 4, CH-4031, Basel, Switzerland

    Andreas J. Bircher MD (Prof.)

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  1. Andreas J. Bircher MD
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Correspondence to Andreas J. Bircher MD .

Editor information

Editors and Affiliations

  1. Dept. Orthopaedic Surgery & Traumatology, Knee Surgery Unit, Kantonsspital Baselland (Bruderholz, Liestal, Laufen), Bruderholz, Switzerland

    Michael T. Hirschmann

  2. Dept. Orthopaedics & Traumatology, Hospital Brandenburg, Brandenburg/Havel, Germany

    Roland Becker

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Bircher, A.J. (2015). 20 Allergy and Hypersensitivity to Implant Materials. In: Hirschmann, M., Becker, R. (eds) The Unhappy Total Knee Replacement. Springer, Cham. https://doi.org/10.1007/978-3-319-08099-4_25

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  • DOI: https://doi.org/10.1007/978-3-319-08099-4_25

  • Publisher Name: Springer, Cham

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  • Online ISBN: 978-3-319-08099-4

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