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Hypersensitivity to Hip and Knee Implants

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Metal Allergy

Abstract

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.

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Abbreviations

AJL:

Aseptic joint loosening

ALTR:

Adverse local tissue reactions

ALVAL:

Aseptic lymphocyte-dominated vasculitis-associated lesion

CoCrMo:

Cobalt-chromium-molybdenum

CRP:

C-reactive protein

ESR:

Erythrocyte sedimentation rate

LTT:

Lymphocyte transformation testing

mLST:

Modified lymphocyte stimulation test

MoM:

Metal-on-metal

MoP:

Metal-on-plastic

PTFE:

Polytetrafluoroethylene

THA:

Total hip arthroplasty

TJR:

Total joint replacements

TKA:

Total knee arthroplasty

THR:

Total hip replacement

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Authors and Affiliations

  1. Harvard Medical School, Boston, MA, 02115, USA

    Lauren N. Ko

  2. Department of Surgery (Dermatology), Geisel School of Medicine at Dartmouth, Hanover, NH, 03755, USA

    Peter C. Schalock

  3. 125 Newbury St., Suite 400, Framingham, MA, 01701, USA

    Peter C. Schalock

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Correspondence to Peter C. Schalock .

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  1. Department of Dermatology, Stanford University School of Medicine, Redwood City, CA, USA

    Jennifer K Chen

  2. Department of Dermatology and Allergy Herlev and Gentofte Hospital University of Copenhagen, Hellerup, Denmark

    Jacob P. Thyssen

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Ko, L.N., Schalock, P.C. (2018). Hypersensitivity to Hip and Knee Implants. In: Chen, J., Thyssen, J. (eds) Metal Allergy. Springer, Cham. https://doi.org/10.1007/978-3-319-58503-1_19

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