Review Article

Biomaterial Hypersensitivity: Is It Real? Supportive Evidence and Approach Considerations for Metal Allergic Patients following Total Knee Arthroplasty

Table 2

Hypersensitivity reactions after total joint arthroplasty in retrospective studies.

Retrospective study titlePublicationAuthorResults

Contact allergy to metals and bone cement components in patients with intolerance of arthroplastyDtsch Med WochenschrEben et al. [15]In cemented TJA: 22/66 symptomatic pts. patch +, asymptomatic patch + 3/26
Allergy to metals as a cause of orthopaedic implant failureInt J Occup Med Environ Health Kręcisz et al. [16]14 poor implants, 8 patch + (7 ni, 6 cr), 3 underwent revision and improved
Early osteolysis following second-generation metal-on-metal hip-replacementJ Bone Joint Surg AmPark et al. [17]8/9 MoM w/osteolysis patch + to Co, 2/9 w/o osteolysis patch +; retrospective
Sensitivity to metal as a possible cause of sterile loosening after cobalt-chromium total hip-replacement arthroplastyJ Bone Joint Surg AmBrown et al. [18]0/20 loose MoM patch + (1977)
Metal sensitivity as a cause of bone necrosis and loosening of the hip prosthesis in total joint replacementJ Bone Joint Surg BrEvans et al. [2]9/14 w/loose joints patch +, 0/24 w/stable joints
Incidence of metal sensitivity in patients with total joint replacementsBr Med JElves et al. [1]15/23 failed TJA patch +, 4/27 stable patch +, 8/13 w/derm rxn were patch +
Dermatitis on the knee following knee replacement: a minority of cases contact allergy to chromate, cobalt, or nickel but a causal association is unprovenContact DermatitisVerma et al. [12]7 of 15 patients w/cutaneous symptoms patch +
Metal sensitivity in patients with metal-to-plastic total hip arthroplastiesActa Orthop ScandCarlsson et al. [11]13/134 MOP patch + postop.; unsure if hypersensitivity caused by THA, but, in pts. w/Hx of allergy, proceed w/caution
Retrospective evaluation of patch testing before or after metal device implantationArch DermatolReed et al. [13]5/22 with history of hypersensitivity preop. patch +, 0/22 referred for patch test postop. were patch +
Lymphocyte responses in patients with total hip arthroplastyJ Orthop ResHallab et al. [14]More + LTT and cytokine release in THA, and esp. in loose THA

Retrospective study summaryRevised: 33/138 (23.9%) patch +, 44/303 (14.5%) patch + in stable TJA
Failed/loose: 113/261 (43.3%) patch +, 32/146 (21.9%) patch + in TJA
Total: 146/399 (36.6%) patch +, 76/449 (16.9%) patch −
10/16 (62.5%) revised TJAs LTT +