Allergic reactions in arthroplasty: myth or serious problem?

Area of Science:

• Orthopedic Surgery
• Allergy and Immunology
• Biomaterials Science

Background:

• Endoprosthetic surgery involves implants that can contain materials like chromium, cobalt, nickel, or cement components.
• Patients with pre-existing sensitization to these materials may be at risk for adverse reactions following implantation.
• Assessing the incidence and impact of allergic reactions in this patient group is crucial for surgical planning and patient outcomes.

Purpose of the Study:

• To determine the prevalence of sensitization to chromium, cobalt, nickel, or cement in patients undergoing endoprosthetic surgery.
• To evaluate the proportion of endoprosthetic revisions attributed to allergic reactions.
• To follow up on patients who underwent revision surgery due to allergic reactions.

Main Methods:

• A cohort of 855 patients with known pre-operative sensitization to chromium, cobalt, nickel, or cement components was identified.
• Patients undergoing primary arthroplasty versus revision surgery were categorized.
• Patients revised for potential allergic reactions were specifically followed post-operatively.

Main Results:

• Of 855 sensitized patients, 17 (2.0%) required revision surgery due to allergic reactions.
• Allergic reactions accounted for 9.8% of revisions in sensitized patients, compared to 0.2% of all endoprosthetic revisions.
• Post-revision surgery, outcome scores improved, with careful avoidance of potential allergens in replaced prostheses.

Conclusions:

• Patients with known allergies to implant components require thorough pre-operative counseling regarding potential risks.
• This study quantifies the incidence of allergic reactions in endoprosthetic treatment, aiding in risk assessment for allergic patients.
• Informed patient choice and meticulous material selection are vital for managing allergic reactions in endoprosthetic surgery.