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Sensitivity to titanium. A cause of implant failure?
P A Lalor1, P A Revell, A B Gray
1London Hospital Medical College, England.
The Journal of Bone and Joint Surgery. British Volume
|January 1, 1991
Summary
Particulate titanium debris was found in hip replacement revision tissues, indicating potential immune responses. While skin tests were mostly negative, some patients reacted to titanium ointments, suggesting localized sensitivity.
Area of Science:
- Biomaterials Science
- Immunology
- Orthopedic Surgery
Background:
- Total hip replacements (THRs) can fail, necessitating revision surgery.
- Titanium alloys are commonly used in orthopedic implants, including screws and femoral heads.
- Concerns exist regarding potential adverse reactions to biomaterials like titanium.
Purpose of the Study:
- To investigate the presence and source of titanium particles in tissues from failed THRs.
- To assess the immunological response to titanium debris in these patients.
- To evaluate the diagnostic utility of skin patch testing for titanium sensitivity.
Main Methods:
- Analysis of tissue samples from five revision THR patients for particulate titanium.
- Immunohistochemical staining to identify immune cells (macrophages, T-lymphocytes, B-lymphocytes).
- Skin patch testing with titanium salts and a titanium-containing ointment.
Main Results:
- Significant amounts of titanium particles were detected in all five patient tissues.
- Macrophages and T-lymphocytes were abundant, suggesting an immune response, with no B-lymphocytes observed.
- Standard skin patch tests with titanium salts were negative, but two patients showed positive reactions to a titanium ointment.
Conclusions:
- Titanium debris from implants is present in tissues surrounding failed THRs.
- An adaptive immune response, specifically involving T-lymphocytes, may be associated with titanium exposure.
- Standard patch testing may not reliably detect titanium sensitivity; localized reactions might occur.