Allergic Dermatitis Following Bilateral Oxidized Zirconium Total Knee Replacements

Total knee replacement (TKR) utilization is expected to increase by 673% in 2030, with patients between the ages of 45 to and 64 years representing the fastest-growingfastest growing age group requiring joint replacement. This group not only demands a higher- performinghigher performing, durable prosthesis but are is also the most likely to be dissatisfied if their expectations are not met. Hypo-allergenic implants have been developed by some implant manufacturers to fill this need, so the occurrence of allergic skin reactions after surgery is unanticipated and can have unwanted consequences if not recognized and managed appropriately.

We present the case of a 55-year-old woman who underwent bilateral staged TKR using oxidized zirconium implants and subsequently developed eczematous skin reactions. In both instances, she presented with a peri-incisional erythematous blistering skin reaction that was successfully treated with topical corticosteroids. Investigations revealed no evidence of infection or allergic-typeallergic type reactions to the metals contained in the knee replacements.

Allergic skin reactions following TKR are very rare, and are not necessarily due to a metal hypersensitivity. Infection must be excluded in all cases and a trial of topical corticosteroids is useful before prior to more aggressive treatment, with the removal of the implant reserved as a last resort. To the best of our knowledge, this is the first case in the literature that reports the occurrence of allergic skin reactions following oxidized zirconium TKRs, and highlights the fact that allergic skin reactions can occur when using hypo-allergenic implants. Surgeons should be aware of this possibility and counsel their patients appropriately during the informed consent process.