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A prospective study concerning the relationship between metal allergy and post-operative pain following total hip and knee arthroplasty

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Abstract

Purpose

A prospective study was conducted to detect whether a relationship exists between metal allergy and post-operative pain in total hip and knee arthroplasty patients. We postulated that to some extent a relationship does exist between them.

Materials and methods

Patients who had undergone total hip and knee arthroplasty surgery because of hip and knee disease were included. The exclusion criteria were patients who were treated with immunosuppressor two weeks pre-operatively, skin conditions around the patch testing site, and other uncontrollable factors. Each patient agreed to patch testing for three days before surgery. Photographic images before patch testing, two and three days after patch testing were obtained to evaluate the final incidence of metal allergy. The patch tests contained 12 metal elements; chromium, cobalt, nickel, molybdenum, titanium, aluminium, vanadium, iron, manganese, tin, zirconium, and copper. Two independent observers evaluated the images. The results were divided into a non-metal allergy group and a metal allergy group. Pre-operative and postoperative VAS score, lymphocyte transforming test, and X-rays were collected to detect the relationship between metal allergy and post-operative pain following total hip and knee arthroplasty.

Results

There were 96 patients who underwent pre-operative patch testing. The overall metal allergy rate was 51.1 % (49/96) in our study. Nickel, cobalt, manganese, and tin were the most common allergic metal elements in our study. Nine inappropriate cases were excluded, and 87 patients were finally included in our study. There were 36 metal allergy and 26 non-metal allergy patients in the THA group, while 11 metal allergy and 14 non-metal allergy patients were found in the TKA group. We found no relationship existed between metal allergy and post-surgery pain in total hip and knee arthroplasty.

Conclusion

Pain caused by metal allergy usually presents as persistent and recurrent pain. The white cell count, C-reactive protein, erythrocyte sedimentation rate and postoperative radiographs were not affected. Currently, patch testing and lymphocyte transforming tests are used for metal allergy diagnosis. We deemed that a relationship between post-surgery pain and metal allergy in total hip and knee patients may exist to some extent. Larger samples and longer follow-up time are essential for further study.

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Acknowledgments

We show much thanks to the Department of Orthopaedics of the First Affiliated Hospital of Traditional Chinese Medicine of Guangzhou University. And the study received financial support from the National Nature Science Fund of the People’s Republic of China (Grant number is 81273784).

Conflict of interest

The authors claim that there exist no conflicts of interest.

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Authors and Affiliations

  1. Orthopadic Department of The First Affiliated Hospital, Guangzhou University of Traditional Chinese Medicine, Guangzhou, China

    Yirong Zeng, Wenjun Feng, Jie Li, Lu Lu, Chuntao Ma, Jianchun Zeng, Feilong Li, Xinyu Qi & Yueguang Fan

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  1. Yirong Zeng
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  2. Wenjun Feng
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  3. Jie Li
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  4. Lu Lu
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Correspondence to Yirong Zeng.

Additional information

Yirong Zeng and Wenjun Feng contributed equally to this article.

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Zeng, Y., Feng, W., Li, J. et al. A prospective study concerning the relationship between metal allergy and post-operative pain following total hip and knee arthroplasty. International Orthopaedics (SICOT) 38, 2231–2236 (2014). https://doi.org/10.1007/s00264-014-2367-1

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  • DOI: https://doi.org/10.1007/s00264-014-2367-1

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