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Nickel allergy does not correlate with function after total knee arthroplasty.

George Chimento1, Jimmy Daher1, Bhumit Desai1

  • 1Department of Orthopaedic Surgery, Ochsner Medical Center, New Orleans, Louisiana, USA.

Knee Surgery, Sports Traumatology, Arthroscopy : Official Journal of the ESSKA
|August 27, 2024
PubMed
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This study found no link between nickel allergy test results and clinical outcomes in patients with well-functioning total knee arthroplasty (TKA). Surgeons should consider other factors before revising TKAs based solely on nickel allergy testing.

Area of Science:

  • Orthopedic surgery
  • Immunology
  • Biomaterials science

Background:

  • Metal allergy (MA) is a growing concern in total knee arthroplasty (TKA).
  • Evaluating the relationship between MA and clinical outcomes in asymptomatic patients with well-functioning implants is crucial.

Purpose of the Study:

  • To determine if a relationship exists between clinical outcomes and nickel allergy in patients with asymptomatic, well-functioning TKAs.
  • To utilize quantitative metal allergy testing to assess this relationship.

Main Methods:

  • A prospective case series of 50 patients with well-functioning TKAs and a minimum 12-month follow-up was conducted.
  • Lymphocyte Transformation Test was used for quantitative metal allergy (MA) testing.
  • Statistical analyses included Cochran-Mantel-Haenzel, Wilcoxon-Mann-Whitney, and Spearman correlation tests.
Keywords:
lymphocyte transformation testmetal allergynickel allergytotal knee arthroplasty

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Main Results:

  • Nickel, cobalt, and chromium demonstrated different reactivity scores, with nickel showing the highest reactivity.
  • Females had significantly higher odds of nickel reactivity compared to males (OR=3.41).
  • No correlation was found between metal stimulation index (SI) and Oxford knee score (OKS) for nickel, cobalt, or chromium.

Conclusions:

  • This study is the first to investigate MA in patients with well-functioning TKAs.
  • Clinical outcomes in well-functioning TKAs are not correlated with nickel reactivity.
  • Caution is advised when considering TKA revision based solely on a positive nickel allergy test; other failure reasons should be investigated.