Related Experiment Video
Updated: Jan 28, 2026
07:26
Systematic Assessment of Mammalian Skull Specimens for Dental and Temporomandibular Joint Pathology
Published on: August 22, 2022
1.9K
Material Hypersensitivity and Alloplastic Temporomandibular Joint Replacement.
Louis G Mercuri1, Marco S Caicedo2
1Visiting Professor, Department of Orthopedic Surgery, Rush University Medical Center, Chicago, IL; Clinical Consultant, TMJ Concepts, Ventura, CA.
Summary
Managing metal hypersensitivity in joint replacements lacks consensus. This review analyzes orthopedic literature to propose an algorithm for diagnosing and treating patients with suspected metal allergies, emphasizing conservative care before device removal.
Area of Science:
- Orthopedic Surgery
- Allergy and Immunology
- Biomaterials Science
Background:
- Growing recognition of metal sensitivity as a complication in orthopedic joint replacements.
- Lack of established guidelines for evaluating and managing patients with suspected metal implant allergies.
- Importance of addressing patient-reported hypersensitivity reactions to metal-containing joint devices.
Purpose of the Study:
- To analyze the current orthopedic literature on the diagnosis, testing, and management of metal hypersensitivity in joint replacement patients.
- To propose a management algorithm for metal hypersensitivity specifically for patients receiving alloplastic temporomandibular joint replacements.
Main Methods:
- Comprehensive review of the orthopedic literature using PubMed searches focused on metal sensitivity in joint replacement.
- Analysis of diagnostic methods, including in vivo skin patch tests and in vitro lymphocyte transformation tests.
- Evaluation of current management strategies, from conservative approaches to device explantation.
Main Results:
- Metal hypersensitivity is often a diagnosis of exclusion, requiring thorough investigation of other potential causes.
- Skin patch and lymphocyte transformation tests are the most common diagnostic tools.
- Conservative management and exclusion of alternative diagnoses are recommended before considering device removal.
Conclusions:
- Pre-operative testing may be beneficial for patients with a history of metal intolerance or prior reactions to metal implants.
- Current literature does not support routine metal hypersensitivity testing for all joint replacement candidates.
- A structured approach is needed for managing suspected metal hypersensitivity in orthopedic implant patients.
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