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Metal hypersensitivity testing in patients undergoing joint replacement: a systematic review.

D Granchi1, E Cenni, A Giunti

  • 1Rizzoli Orthopaedic Institute, Laboratory for Orthopaedic Pathophysiology and Regenerative Medicine, Via di Barbiano 1/10, 40136 Bologna, Italy. donatella.granchi@ior.it

The Journal of Bone and Joint Surgery. British Volume
|July 31, 2012
PubMed
Summary

Metal hypersensitivity risk increases after total joint replacement (TJR), particularly with implant failure. While testing is not definitive for failed implants, it may benefit patients with prior metal allergy or uncertain loosening causes.

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Area of Science:

  • Orthopedic Surgery
  • Biomaterials Science
  • Immunology

Background:

  • Metal hypersensitivity is a concern in patients undergoing total joint replacement (TJR).
  • Understanding the post-operative risk and diagnostic utility of metal sensitivity testing is crucial for patient outcomes.

Purpose of the Study:

  • To systematically review and meta-analyze the literature on metal sensitivity testing in TJR patients.
  • To assess the risk of post-operative metal hypersensitivity and its association with TJR outcomes.
  • To investigate the advantages and diagnostic value of hypersensitivity testing in TJR.

Main Methods:

  • Systematic review and meta-analysis of peer-reviewed literature.
  • Comprehensive search of PubMed and EMBASE databases.

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Last Updated: May 20, 2026

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  • Inclusion of 22 articles involving 3634 patients.

    • Main Results:

    • Positive metal sensitivity tests increased post-TJR, especially in cases of implant failure or metal-on-metal couplings.
    • The odds of developing metal allergy were higher post-operatively (OR 1.52) and significantly increased with failed implants (OR 2.76).
    • Hypersensitivity testing did not statistically differentiate between stable and failed TJRs, lacking proven predictive value.

    Conclusions:

    • Post-operative metal hypersensitivity is a recognized risk following total joint replacement.
    • Metal sensitivity testing may be beneficial for TJR patients with a history of metal allergy or in cases of failed implants, particularly those with metal-on-metal components.
    • Further research is needed to clarify the predictive value of hypersensitivity testing in TJR.