[Hypersensitivity to metals in patients with orthopedic implants]

Area of Science:

• Biomaterials Science
• Immunology
• Orthopedic Surgery

Background:

• Metals in biological systems undergo corrosion, forming metallic ions (haptens).
• These haptens can bind to proteins, potentially triggering an immune response and hypersensitivity.
• Cutaneous lesions and inflammatory reactions near implants may indicate hypersensitivity to metallic materials.

Purpose of the Study:

• To review the current understanding of hypersensitivity to metallic orthopedic implants.
• To highlight the association between metal corrosion products and adverse skin reactions.
• To address the lack of reliable diagnostic methods for metal hypersensitivity in implant patients.

Main Methods:

• Literature review of studies on metal corrosion, immune responses, and orthopedic implant outcomes.
• Analysis of reported cases of cutaneous reactions associated with metallic implants.
• Discussion of the identified cellular and humoral immune responses to implanted metals.

Main Results:

• Corrosion products from metallic implants can lead to haptens, inducing immune responses.
• Adverse skin reactions like dermatitis, urticaria, and vasculitis are linked to implant corrosion.
• Patients with failed implants show a higher frequency of cutaneous lesions compared to those with successful implants.

Conclusions:

• Hypersensitivity to metals is a recognized phenomenon in orthopedic implants, though the overall risk appears low.
• The precise contribution of metal hypersensitivity to implant failure remains largely unknown.
• Development of reliable diagnostic tests for metal hypersensitivity is needed.