Metal Allergy pp 249-262 | Cite as

Hypersensitivity to Hip and Knee Implants

  • Lauren N. Ko
  • Peter C. SchalockEmail author


Prosthetic hip and knee implantations rank among the most common elective operations in the United States and Europe. These implants are compositionally complex and have undergone drastic evolutions over the past several decades. Hypersensitivity reactions to hip and knee implant components are well documented in the literature but remain uncommon. They range from localized dermatitis to implant loosening and subsequent failure. Currently, patch testing is the most useful method to evaluate for metal allergy. Preimplantation testing is not necessary unless patients have a significant history of skin rashes after metal contact or previously have experienced device failure. Postoperative complications such as aseptic loosening, chronic pain, or new, unexplained local or regional dermatitis may occasionally benefit from evaluation for metal allergy. Clinical next steps following implantation may be challenging. If the implant is symptomatic, topical or systemic corticosteroids may be tried, but ultimately, the surgeon and patient may need to decide whether replacement with a less allergenic alternative is feasible and safe. Whether pre- or postoperative, clinical decisions should be made by the collaborative efforts of dermatologists, allergists, and surgeons. Prospective trials in this field are still necessary to develop an evidence-based approach to the treatment of patients with allergic reactions to metal, as current clinicians are guided largely by expert opinion.



Aseptic joint loosening


Adverse local tissue reactions


Aseptic lymphocyte-dominated vasculitis-associated lesion




C-reactive protein


Erythrocyte sedimentation rate


Lymphocyte transformation testing


Modified lymphocyte stimulation test








Total hip arthroplasty


Total joint replacements


Total knee arthroplasty


Total hip replacement


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Copyright information

© Springer International Publishing AG, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Harvard Medical SchoolBostonUSA
  2. 2.Department of Surgery (Dermatology)Geisel School of Medicine at DartmouthHanoverUSA
  3. 3.FraminghamUSA

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