Related Experiment Video
Updated: Feb 25, 2026
10:28
Biological Compatibility Profile on Biomaterials for Bone Regeneration
Published on: November 16, 2018
13.4K
Bone Cement Hypersensitivity: Clinical Presentation, Diagnosis, and the Role of Patch Testing
Troy A Black1, Annabel Shen1, Megan N Rogge2
1From the, McGovern Medical School, The University of Texas Health Science Center at Houston, Houston, Texas, USA.
Dermatitis : Contact, Atopic, Occupational, Drug
|February 24, 2026
Summary
Hypersensitivity reactions to bone cement (polymethyl methacrylate-based) are often missed. Patch testing is key for diagnosing allergies to bone cement components like PMMA, benzoyl peroxide, and gentamicin.
Area of Science:
- Orthopedics
- Dermatology
- Materials Science
Background:
- Bone cement, primarily polymethyl methacrylate (PMMA), is extensively used in orthopedic and dental surgery.
- Hypersensitivity reactions to bone cement are underrecognized and can be misdiagnosed as infection or mechanical failure.
Purpose of the Study:
- To review clinical features, diagnosis, and management of bone cement hypersensitivity.
- To evaluate the diagnostic utility of patch testing and other methods.
Main Methods:
- Systematic review of 17 publications.
- Analysis of 439 patients undergoing patch testing for bone cement hypersensitivity.
Main Results:
- Polymethyl methacrylate (PMMA) showed the highest sensitization rate.
- Benzoyl peroxide, N,N-dimethyl-p-toluidine, and gentamicin sulfate also identified as common allergens.
- Patch testing is the primary diagnostic tool, with lymphocyte transformation testing and histology as adjunctive methods.
Conclusions:
- Increased clinical awareness is crucial for timely diagnosis and management of bone cement hypersensitivity.
- Management involves corticosteroids, antihistamines, and consideration of alternative materials for sensitized patients.
Related Concept Videos
01:19Hypersensitivity Reactions: Immune-Complex Reactions
62
Type III hypersensitivity reactions occur when antigen–antibody complexes form and activate the complement system. Normally, these complexes help the clearance of antigens by phagocytes and red blood cells. However, when large numbers of immune complexes are present, they can deposit in tissues—particularly in the walls of blood vessels—leading to inflammation and tissue injury. These deposits trigger complement activation and neutrophil recruitment, resulting in serum...
62
01:30Drug Toxicity: Allergic Reactions
58
Drug-related allergies are immune-mediated responses triggered by the administration of pharmacological agents. These hypersensitivity reactions are classified based on the immune mechanisms involved. The four primary types—Type I, II, III, and IV—are mediated by different immunological pathways and exhibit distinct clinical manifestations.Type I Hypersensitivity/ IgE-Mediated Reactions: Immunoglobulin E (IgE) immediately mediates Type I hypersensitivity reactions. Upon initial...
58
01:30Hypersensitivities
7.9K
Hypersensitivity, also known as a hypersensitivity reaction or allergic reaction, is a condition where the body's immune system reacts abnormally to a foreign substance. Such substances, that cause hypersensitivity are referred to as an allergen, could be something typically harmless to most people, like pollen or certain foods.
Types of Hypersensitivities
Hypersensitivity reactions are categorized into four types: Type 1, Type 2, Type 3, and Type 4. Each type has a distinct mechanism...
Types of Hypersensitivities
Hypersensitivity reactions are categorized into four types: Type 1, Type 2, Type 3, and Type 4. Each type has a distinct mechanism...
7.9K
01:29Blood and Nerve Supply to the Bones
14.2K
Bones are dynamic organs that require a rich supply of oxygen and nutrients. Around 5% to 10% of the cardiac output supplies blood to the bones. A typical long bone has three main sources: the nutrient artery, the metaphyseal and epiphyseal arteries, and the periosteal arteries.
Nutrient Artery
The nutrient artery is the main blood vessel that enters the diaphysis via the nutrient foramen. While most long bones have only one nutrient foramen, large bones, such as the femur, may have two. This...
Nutrient Artery
The nutrient artery is the main blood vessel that enters the diaphysis via the nutrient foramen. While most long bones have only one nutrient foramen, large bones, such as the femur, may have two. This...
14.2K
01:17Soundness of Cement
611
The soundness of cement refers to the ability of cement paste to retain its volume after setting. Unsound cement can lead to expansion and structural damage due to the presence of free lime, magnesia, and calcium sulfate. Free lime hydrates very slowly, expanding and causing unsoundness, which is difficult to detect because it intercrystallizes with other compounds. Magnesia also reacts with water, forming crystals that can disrupt the cement's structure. Calcium sulfate can create...
611
01:29Hypersensitivity Reactions: Delayed Hypersensitivity Reactions
72
Delayed-Type Hypersensitivity (DTH), or Type IV hypersensitivity, is a cell-mediated immune response. It occurs when T cells, rather than antibodies, mediate a reaction to specific antigens. It is characterized by a delayed onset (1-2 days) and involves the recruitment of macrophages to the inflammation site.The initiation of a DTH response begins with the sensitization of T cells. During this phase, which lasts at least 1-2 weeks, antigen-specific T cells are activated, clonally expanded, and...
72