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International Orthopaedics

, Volume 43, Issue 10, pp 2323–2331 | Cite as

A case series of cementless revision total knee arthroplasty in patients with benzoyl peroxide allergy

  • Frank S. FröschenEmail author
  • Nadine Gravius
  • Jan-Frederic Lau
  • Thomas Martin Randau
  • Eva Kaup
  • Max J. Friedrich
  • Sascha Gravius
Original Paper
  • 189 Downloads

Abstract

Purpose

The contact allergens nickel, cobalt, and chromium are often discussed as possible triggers of allergic reactions to orthopedic implants. Additionally, acrylates and polymerization additives in bone cement (e.g., benzoyl peroxide (BPO)) have been implicated as triggers of eczema, wound healing disorders, and aseptic implant loosening. We report about six patients with aseptic loosening after total knee arthroplasty (TKA), who underwent revision surgery after testing positive for BPO hypersensitivity.

Methods

After clarification of possible other causes of implant failure, epicutaneous testing had been performed and the implants were replaced in a two-stage procedure with cementless, diaphyseal anchoring, hypoallergenic (TiNb-coated) revision endoprostheses.

Results

Epicutaneous testing revealed a BPO allergy in all six patients and an additional nickel allergy in three of the six patients. There was no histopathological or microbiological evidence for a periprosthetic infection. The clinical follow-up showed a low level of pain with good function, a stable knee joint, and proper implant position. The Knee Society Score (KSS) with its subscales Knee Score and Functional Score improved post-operatively from 43 to 70 points and from 47.5 to 68.3 points, respectively. Two implant-specific complications occurred: femoral stress shielding two years post-operatively with no further need for action and aseptic loosening of the tibial stem with the need of revision three years post-operatively.

Conclusions

The regression of complaints after replacement with cementless and nickel-free revision implants suggests allergic implant intolerance. Implantation of a cementless, hypoallergenic endoprosthesis might, therefore, be a surgical treatment strategy in patients with evidence of allergies.

Keywords

Allergy Benzoyl peroxide Nickel Metal Bone cement Total knee arthroplasty Revision 

Notes

Compliance with ethical standards

Conflict of interest

S. Gravius has received a speaker honorarium from Waldemar LINK GmbH and financial support from Waldemar LINK GmbH to participate at a surgery course. The other authors declare that they have no conflict of interest. No benefits have been or will be received from a commercial party related directly or indirectly to the subject matter of this article.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards. For this type of study, formal consent is not required.

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Copyright information

© SICOT aisbl 2018

Authors and Affiliations

  • Frank S. Fröschen
    • 1
    Email author
  • Nadine Gravius
    • 1
  • Jan-Frederic Lau
    • 2
  • Thomas Martin Randau
    • 1
  • Eva Kaup
    • 1
  • Max J. Friedrich
    • 1
  • Sascha Gravius
    • 1
  1. 1.Department of Orthopaedics and Trauma SurgeryUniversity Hospital BonnBonnGermany
  2. 2.Department of PathologyUniversity Hospital BonnBonnGermany

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