PATIENTS WITH SUSPECTED METAL IMPLANT ALLERGY: POTENTIAL CLINICAL PICTURES AND ALLERGOLOGICAL DIAGNOSTIC APPROACH (REVIEW)

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Abstract

The focus of this review are allergic complications following insertion of metallic orthopedic implants. Such potential allergic reactions encompass eczema, impaired wound and fracture healing, infection-mimicking reactions, effusions, pain and loosening. Nickel, cobalt and chromium seem to be the predominant eliciting allergens. Allergy might be considered prior to planned orthopaedic surgery or in patients with complications following arthroplasty We recommend, that differential diagnoses - in particular infection -should always be excluded in cooperation with surgery collegues. The clinical work up of a patient suspected of suffering from metal implant allergy should include a combined evaluation of medical history, clinical findings, patch testing and histology In vitro testing, namely the lymphocyte transformation test (LTT), can indicate metal sensitization, but needs careful interpretation.

About the authors

P. Thomas

Ludwig-Maximilians-University

Author for correspondence.
Email: Peter.Thomas@med.uni-muenchen.de
Russian Federation

M. Thomsen

DRK Hospital, Orthopedics and Trauma Surgery

Email: noemail@neicon.ru
Russian Federation

V. Krenn

Center for Histology, Cytology and Molecular Diagnostics

Email: noemail@neicon.ru
Russian Federation

B. Summer

Ludwig-Maximilians-University

Email: noemail@neicon.ru
Russian Federation

References

  1. Aneja S., Taylor J.S., Billings S.D., Honari G., Sood A. Post-implantation erythema in 3 patients and a review of reticular telangiectatic erythema. Contact Dermatitis. 2011; 64(5):280-288.
  2. Basko-Plluska J.L., Thyssen J.P., Schalock P.C. Cutaneous and systemic hypersensitivity reactions to metallic implants. Dermatitis. 2011; 22(2):65-79.
  3. Bircher A., Friederich N.F., Seelig W., Scherer K. Allergic complications from orthopaedic joint implants: the role of delayed hypersensitivity to benzoyl peroxide in bone cement. Contact Dermatitis. 2012; 66(1):20-26.
  4. Brehler R.G. J., Eichelberg D. Nickelallergie nach Plattenosteosynthese. Akt Dermatol. 1990;16:2.
  5. Caicedo M.S., Samelko L., McAllister K., Jacobs J.J., Hallab N.J. Increasing both CoCrMo-alloy particle size and surface irregularity induces increased macrophage inflammasome activation in vitro potentially through lysosomal destabilization mechanisms. Journal of orthopaedic research: official publication of the Orthopaedic Research Society. 2013; 31(10):1633-1642.
  6. Claes L., Kirschner P., Perka C., Rudert M., eds. AE-Manual der Endoprothetik, Bd XVI. Hüfte und Hüftrevision. Heidelberg - Dordrecht - London - New York: Springer; 2012.
  7. Dietrich K.A., Mazoochian F., Summer B., Reinert M., Ruzicka T., Thomas P. Intolerance reactions to knee arthroplasty in patients with nickel/cobalt allergy and disappearance of symptoms after revision surgery with titanium-based endoprostheses. J. Dtsch. Dermatol. Ges. 2009; 7(5):410-413.
  8. Eben R., Walk R., Summer B., Maier S., Thomsen M., Thomas P. Implant allergy register - a first report. Orthopäde. 2009; 38(6):557-562.
  9. Eis D.W. "Qualitätssicherung beim Lymphozytentransformationstest" - Addendum zum LTT-Papier der RKI-Kommission "Methoden und Qualitätssicherung in der Umweltmedizin". Bundesgesundheitsblatt Gesundheitsforschung Gesundheitsschutz. 2008; 51:1070-1076.
  10. Fitzgerald S.J., Trousdale R.T. Why knees fail in 2011: patient, surgeon, or device? Orthopedics. 2011; 34(9):e513-515.
  11. Gabel M.S., Thomas P. Persistierende Entzündung nach Großzehenkorrekturoperation bei einer Patientin mit Nickelallergie: Manifestation einer Überempfindlichkeit gegen Metallpartikel? Fuß & Sprunggelenk. 2008; 6:5.
  12. Geier J., Lessmann H., Becker D., Thomas P. Allergy diagnostics in suspected implant intolerance: practical approach. A position paper of the German Contact Dermatitis Research Group (DKG). Hautarzt. 2008; 59(7):594-597.
  13. Granchi D., Cenni E., Giunti A., Baldini N. Metal hypersensitivity testing in patients undergoing joint replacement: a systematic review. J. Bone Joint Surg. 2012; 94-B(8):1126-1134.
  14. Grekin S., Mesfin M., Kang S., Fullen D.R. Intralymphatic histiocytosis following placement of a metal implant. J. Cutan. Pathol. 2011; 38(4):35135-3.
  15. Kanerva L., Forstrom L. Allergic nickel and chromate hand dermatitis induced by orthopaedic metal implant. Contact Dermatitis. 2001; 44(2):103-104.
  16. Krenn V., Morawietz L., Kienapfel H., Ascherl R., Matziolis G., Hassenpflug J. et al. Revised consensus classification. Histopathological classification of diseases associated with joint endoprostheses. Z. Rheumatol. 2013; 72(4):383-392.
  17. Krenn V., Otto M., Morawietz L., Hopf T., Jakobs M., Klauser W. et al. Histopathologic diagnostics in endoprosthetics: periprosthetic neosynovialitis, hypersensitivity reaction, and arthrofibrosis. Orthopäde. 2009; 38(6):520-530.
  18. Kulichova T., Schaefer T., Kendoff D., Summer B., Parvizi J., Thomas P. Metal hypersensitivity mimicking periprosthetic erysipelas-like infection. J. Bone Joint Surg. Case Connector. 2014; accepted.
  19. McKenzie A.W., Aitken C.V., Ridsdill-Smith R. Urticaria after insertion of Smith-Petersen Vitallium nail. Br. Med. J. 1967; 4 (5570):36.
  20. Pichler W.J., Tilch J. The lymphocyte transformation test in the diagnosis of drug hypersensitivity. Allergy. 2004; 59(8):809-820.
  21. Australian Orthopaedic Association National Joint Replacement (AOANJR) Registry. Annual Report. 2009.
  22. Renz H., Becker W.M., Bufe A., Kleine-Tebbe J., Raulf-Heimsoth M., Saloga J. et al. In vitro allergy diagnosis. Guideline of the German Society of Asthma and Immunology in conjunction with the German Society of Dermatology. J. Dtsch. Dermatol. Ges. 2006; 4(1):72-85.
  23. Schafer T., Bohler E., Ruhdorfer S., Weigl L., Wessner D., Filipiak B. et al. Epidemiology of contact allergy in adults. Allergy. 2001; 56(12):1192-1196.
  24. Schnuch A., Aberer W., Agathos M., Becker D., Brasch J., Elsner P. et al. Performing patch testing with contact allergens. J. Dtsch. Dermatol. Ges. 2008; 6(9):770-775.
  25. Ständer S.T., Rueff F., Summer B. Comparative assessment of nickel sensitization based on medical history, patch test and lymphocyte transformation test. Allergo J. Int. 2014; 23:1.
  26. Summer B., Paul C., Mazoochian F., Rau C., Thomsen M., Banke I. et al. Nickel (Ni) allergic patients with complications to Ni containing joint replacement show preferential IL-17 type reactivity to Ni. Contact Dermatitis. 2010; 63(1):15-22.
  27. Thienpont E., Berger Y. No allergic reaction after TKA in a chrome-cobalt-nickel-sensitive patient: case report and review of the literature. Knee Surgery, Sports Traumatol. Arthroscopy. 2013; 21(3):636-640.
  28. Thomas P., Braathen L.R., Dorig M., Aubock J., Nestle F., Werfel T. et al. Increased metal allergy in patients with failed metal-on-metal hip arthroplasty and periimplant T-lymphocytic inflammation. Allergy. 2009; 64(8):1157-1165.
  29. Thomas P., Schuh A., Ring J., Thomsen M. Orthopedic surgical implants and allergies: joint statement by the implant allergy working group (AK 20) of the DGOOC (German association of orthopedics and orthopedic surgery), DKG (German contact dermatitis research group) and dgaki (German society for allergology and clinical immunology). Orthopäde. 2008; 37(1):75-88.
  30. Thomas P., Stauner K., Schraml A,. Mahler V., Banke I.J., Gollwitzer H. et al. Characteristics of 200 patients with suspected implant allergy compared to 100 symptom-free arthroplasty patients. Orthopäde. 2013; 42(8):607-613.
  31. Thomas P., Thomas M., Summer B., Dietrich K., Zauzig M., Steinhauser E. et al. Impaired wound-healing, local eczema, and chronic inflammation following titanium osteosynthesis in a nickel and cobalt-allergic patient: a case report and review of the literature. J. Bone Joint Surg. 2011; 93-A(11):e61.
  32. Thomas P., Thomsen M. Implant allergies. Hautarzt. 2010; 61(3):255-262
  33. Thomas P.H., Schopf C., Thomsen M., Frommelt L., Schneider J., Flaig M. et al. Periimplant histology and cytokine pattern in metal-allergic knee arthroplasty patients with improvement after revision with hypoallergenic materials. Sem. Arthroplasty. 2012; 23(4):268-272.
  34. Thyssen J.P., Menne T., Schalock P.C., Taylor J.S., Maibach H.I. Pragmatic approach to the clinical work-up of patients with putative allergic disease to metallic orthopaedic implants before and after surgery. Br. J. Dermatol. 2011; 164(3):473-478.
  35. Wengler A., Nimptsch U., Mansky T. Hip and knee replacement in Germany and the USA - analysis of individual inpatient data from German and US hospitals for the years 2005 to 2011. Ärzteblatt Int. 2014; 111(23-24):9.

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