Metal sensitivity in patients with orthopaedic implants: a prospective study.

Area of Science:

• Orthopaedic surgery
• Immunology
• Materials science

Background:

• Metal sensitization is an unpredictable complication in orthopaedic implant recipients.
• This can negatively impact implant performance and patient outcomes.

Purpose of the Study:

• To evaluate preoperative methods for identifying metal sensitivity in joint replacement candidates.
• To determine the incidence of metal sensitivity one year post-implantation.
• To assess the clinical relevance of patch tests and lymphocyte transformation tests (LTT-MELISA®).

Main Methods:

• 100 patients undergoing hip or knee arthroplasty were assessed pre- and post-implantation.
• Patch testing with implant metals was performed.
• A subset of 20 patients also underwent lymphocyte transformation tests (LTT-MELISA®).

Main Results:

• Preoperative history and testing showed discrepancies in identifying nickel sensitivity.
• Five patients initially testing negative developed positive metal sensitivity results one year post-implantation.
• Patch tests and LTT-MELISA® revealed potential prosthesis-induced sensitization.

Conclusions:

• Preoperative history alone is insufficient for identifying patients with metal sensitivity.
• Post-implantation sensitization suggests orthopaedic implants may induce allergic reactions.
• Objective preoperative metal sensitivity testing is crucial for prosthesis selection and optimizing implant performance.