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

Table 3

Summary of case reports of metallic knee implant associated hypersensitivity reactions.

	Number of implants	Patient gender	History of metal allergy	Implant components	Presenting signs and symptoms	Patch test result	LTT result	Initial implant outcome	Treatment	Revision implant components
Beecker et al. [52]	2 (1 patient)	Female	Yes	Cobalt-chromium alloy	Erythema, edema, heat, eczema	Cobalt, nickel		Stable	Triamcinolone, diphenhydramine
Bergschmidt et al. [48]	1	Female		Cobalt-chromium alloy	Arthralgia, heat, decreased ROM	Nickel sulfate, palladium chloride		Stable	Revision	Ceramic, titanium
Dietrich et al. [54]	4	Female	Yes	Cobalt-chromium-molybdenum alloy	Arthralgia, erythema, edema	Cobalt, nickel	Cobalt, nickel	Stable (3); Failure (1)	Revision	Titanium
Gao et al. [55]	1	Male	No	Cobalt-chromium-molybdenum alloy	Eczema, systemic dermatitis, decreased ROM	Chromium		Stable	Revision	Zirconium-niobium alloy
Handa et al. [49]	1	Male	No	Copper-chromium alloy	Eczema, exudate	Cobalt, copper		Stable
Oiso et al. [51]	1	Male		Cobalt-chromium alloy	Erythema, edema, arthralgia, fever	Cobalt, chromium, nickel, manganese		Stable	Revision	Ceramic, titanium
Thomsen et al. [50]	1	Female			Arthralgia, eczema decreased ROM		Negative	Stable	Revision	Zirconium-nitride coating
van Opstal and Verheyden [53]	1	Female	Yes	Titanium-aluminum-vanadium	Arthralgia, eczema, edema	Negative		Failure	Revision	Zirconium alloy
Verma et al. [12]	15	Female (13); Male (2)	No	Cobalt-chromium alloy	Eczema	Nickel (4); Chromium (2); Cobalt (1)		Stable	Topical corticosteroid