TY - JOUR

T1 - The association between metal allergy, total knee arthroplasty, and revision

T2 - study based on the Danish Knee Arthroplasty Register

AU - Münch, Henrik J

AU - Jacobsen, Stig

AU - Olesen, Jens T

AU - Menné, Torkil

AU - Søballe, Kjeld

AU - Johansen, Jeanne D

AU - Thyssen, Jacob P

PY - 2015

Y1 - 2015

N2 - BACKGROUND AND PURPOSE: It is unclear whether delayed-type hypersensitivity reactions against implanted metals play a role in the etiopathogenesis of malfunctioning total knee arthroplasties. We therefore evaluated the association between metal allergy, defined as a positive patch test reaction to common metal allergens, and revision surgery in patients who underwent knee arthroplasty.PATIENTS AND METHODS: The nationwide Danish Knee Arthroplasty Register, including all knee-implanted patients and revisions in Denmark after 1997 (n = 46,407), was crosslinked with a contact allergy patch test database from the greater Copenhagen area (n = 27,020).RESULTS: 327 patients were registered in both databases. The prevalence of contact allergy to nickel, chromium, and cobalt was comparable in patients with and without revision surgery. However, in patients with 2 or more episodes of revision surgery, the prevalence of cobalt and chromium allergy was markedly higher. Metal allergy that was diagnosed before implant surgery appeared not to increase the risk of implant failure and revision surgery.INTERPRETATION: While we could not confirm that a positive patch test reaction to common metals is associated with complications and revision surgery after knee arthroplasty, metal allergy may be a contributor to the multifactorial pathogenesis of implant failure in some cases. In cases with multiple revisions, cobalt and chromium allergies appear to be more frequent.

AB - BACKGROUND AND PURPOSE: It is unclear whether delayed-type hypersensitivity reactions against implanted metals play a role in the etiopathogenesis of malfunctioning total knee arthroplasties. We therefore evaluated the association between metal allergy, defined as a positive patch test reaction to common metal allergens, and revision surgery in patients who underwent knee arthroplasty.PATIENTS AND METHODS: The nationwide Danish Knee Arthroplasty Register, including all knee-implanted patients and revisions in Denmark after 1997 (n = 46,407), was crosslinked with a contact allergy patch test database from the greater Copenhagen area (n = 27,020).RESULTS: 327 patients were registered in both databases. The prevalence of contact allergy to nickel, chromium, and cobalt was comparable in patients with and without revision surgery. However, in patients with 2 or more episodes of revision surgery, the prevalence of cobalt and chromium allergy was markedly higher. Metal allergy that was diagnosed before implant surgery appeared not to increase the risk of implant failure and revision surgery.INTERPRETATION: While we could not confirm that a positive patch test reaction to common metals is associated with complications and revision surgery after knee arthroplasty, metal allergy may be a contributor to the multifactorial pathogenesis of implant failure in some cases. In cases with multiple revisions, cobalt and chromium allergies appear to be more frequent.

KW - Adolescent

KW - Adult

KW - Aged

KW - Aged, 80 and over

KW - Arthroplasty, Replacement, Knee

KW - Child

KW - Chromium

KW - Cobalt

KW - Denmark

KW - Dermatitis, Contact

KW - Female

KW - Humans

KW - Hypersensitivity, Delayed

KW - Incidence

KW - Knee Joint

KW - Knee Prosthesis

KW - Male

KW - Metal-on-Metal Joint Prostheses

KW - Metals

KW - Middle Aged

KW - Nickel

KW - Patch Tests

KW - Registries

KW - Reoperation

KW - Retrospective Studies

KW - Treatment Failure

KW - Young Adult

U2 - 10.3109/17453674.2014.999614

DO - 10.3109/17453674.2014.999614

M3 - Journal article

C2 - 25582229

VL - 86

SP - 378

EP - 383

JO - Acta Orthopaedica

JF - Acta Orthopaedica

SN - 1745-3674

IS - 3

ER -