Nickel hypersensitivity and skin patch testing in total hip replacement surgery: a systematic review

Area of Science:

• Orthopedic Surgery
• Biomaterials Science
• Allergy and Immunology

Background:

• Approximately 60,000 cemented femoral stems, often nickel-containing, are implanted annually in the UK.
• Nickel hypersensitivity affects up to 13% of the population, raising concerns for total hip replacement (THR) outcomes.
• The potential impact of nickel allergy on THR complications requires investigation.

Purpose of the Study:

• To review the literature on the association between nickel hypersensitivity and THR complications.
• To evaluate the utility of pre-operative patch testing for nickel allergy in THR patients.

Main Methods:

• A systematic literature search was conducted across PubMed, MEDLINE, and EMBASE databases.
• Twenty-six studies involving 1852 patients undergoing primary or revision THR were included.
• Study quality and evidence levels were assessed using established criteria.

Main Results:

• Prevalence of nickel hypersensitivity ranged from 1.5% to 33.3% in included studies.
• Five studies suggested an increase in nickel hypersensitivity post-THR, while four reported a decrease.
• Eight studies indicated a potential link between metal hypersensitivity and THR complications, but seven did not support this association.

Conclusions:

• No definitive link was established between nickel hypersensitivity and total hip replacement complications.
• The role and indication for routine pre-operative patch testing in THR patients remain unclear.
• Further large-scale studies are needed to clarify this relationship and guide implant selection.