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A literature review and expert consensus statement on diagnostics in suspected metal implant allergy.

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Basophil Activation Test for Allergy Diagnosis
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Implant allergy.

P Thomas1, B Summer1

  • 1Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, Munich, Germany.

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|November 8, 2018
PubMed
Summary
This summary is machine-generated.

Implant allergy, though rare, can manifest as various symptoms. Diagnosis involves excluding infection and using patch tests and tissue analysis. Titanium is recommended for allergic patients, while metal-metal joint replacements are discouraged.

Keywords:
allergybone cementchromiumcobaltendoprosthesishistopathologyimplantmetalnickelosteosynthesispatch test

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Area of Science:

  • Orthopedic surgery
  • Allergy and immunology
  • Biomaterials science

Background:

  • Osteosynthesis and artificial joint replacements are standard clinical procedures.
  • Implant complications are typically mechanical or infectious, but material intolerance is a concern.
  • Allergic reactions to implant materials like nickel, chromium, cobalt, acrylates, and gentamicin can cause symptoms such as eczema, delayed healing, effusion, pain, and loosening.

Purpose of the Study:

  • To review the clinical presentation, diagnosis, and management of implant allergies.
  • To highlight the rarity of implant allergies compared to cutaneous metal allergies.
  • To provide recommendations for material selection in metal-allergic patients undergoing orthopedic procedures.

Main Methods:

  • Review of clinical manifestations and diagnostic approaches for implant allergy.
  • Discussion of differential diagnoses, emphasizing infection exclusion.
  • Integration of allergological diagnostics (patch testing) and histopathology of peri-implant tissue.
  • Analysis of risk factors for sensitization and allergic reactions.

Main Results:

  • Implant allergies are rare despite a high incidence of cutaneous metal allergy.
  • Diagnosis relies on excluding infection and employing patch testing and histopathology.
  • Manifestations include eczema, delayed healing, effusion, pain, and implant loosening.
  • Risk factors for sensitization and allergic reactions remain largely unknown.

Conclusions:

  • Titanium-based osteosynthesis materials are recommended for metal-allergic patients.
  • Metal-metal couplings in arthroplasty are generally not advised for patients with metal allergies.
  • Informed consent is crucial if a cobalt-chromium-polyethylene articulation is considered for allergic patients.