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BioMed Research International
Volume 2015, Article ID 137287, 10 pages
Review Article

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

1Division of Orthopaedics and Rehabilitation, Department of Surgery, Southern Illinois University School of Medicine, P.O. Box 19679, Springfield, IL 62794-9679, USA
2Department of Orthopaedic Surgery & Biomedical Engineering, University of Tennessee, Memphis, TN 38017, USA
3Clinic for Orthopaedic Surgery, Campus Grosshadern, Ludwig Maximilians University, 80539 Munich, Germany
4Aesculap AG, Research & Development, 78532 Tuttlingen, Germany
5Colorado Joint Replacement, Denver, CO 80210, USA
6Department of Orthopaedic Surgery, Stanford University School of Medicine, Redwood City, CA 94063, USA

Received 28 August 2014; Accepted 19 September 2014

Academic Editor: Sandra Utzschneider

Copyright © 2015 Andrew J. Mitchelson et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


The prospect of biomaterial hypersensitivity developing in response to joint implant materials was first presented more than 30 years ago. Many studies have established probable causation between first-generation metal-on-metal hip implants and hypersensitivity reactions. In a limited patient population, implant failure may ultimately be related to metal hypersensitivity. The examination of hypersensitivity reactions in current-generation metal-on-metal knee implants is comparatively limited. The purpose of this study is to summarize all available literature regarding biomaterial hypersensitivity after total knee arthroplasty, elucidate overall trends about this topic in the current literature, and provide a foundation for clinical approach considerations when biomaterial hypersensitivity is suspected.