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Screening for symptomatic metal sensitivity: a prospective study of 92 patients undergoing total knee arthroplasty.

Abstract：

:Metal sensitivity (MS) reactions to implant metals represent a rare but well-documented complication following total joint arthroplasty (TJA). Although 20-25% of post-TJA patients develop MS, only a few highly susceptible patients (< 1%) exhibit symptoms. Whether surgeons should perform screening for MS is currently a matter of debate. The present study investigated the clinical importance of screening for patients predisposed to symptomatic MS, and the specific metals causing symptomatic MS following total knee arthroplasty (TKA). Between 2000 and 2002, a total of 108 primary TKAs were performed on 92 patients. Preoperatively, all patients underwent modified lymphocyte stimulation test (mLST) to Ni, Co, Cr, and Fe. Of the 92 patients, 24 (26%) displayed positive preoperative responses to at least one metal. Five patients displayed implant metal-related eczema and were all mLST-positive preoperatively, suggesting that screening for symptomatic MS is clinically useful. Two of these underwent revision TKA and thereafter, eczema healed and mLST results changed from positive to negative. All mLST-positive patients were divided into three groups: Group I, patients with eczema; Group II, patients with clear history of MS; and Group III, patients neither eczema nor history of MS. When the type of sensitive metals were compared among the three groups, a significant association between presence of Cr-sensitivity and development of eczema (P < 0.05) was identified. No significant association was observed between other metals and development of eczema or history of MS. This indicates that Cr is a potential candidate metal for causing eczema in our TKA series, and Cr-sensitivity may offer a potential predictor for symptomatic MS. The present study indicates that the surgeons should undertake routine preoperative screening for MS, particularly to Cr.

journal_name

Biomaterials

journal_title

Biomaterials

authors

Niki Y,Matsumoto H,Otani T,Yatabe T,Kondo M,Yoshimine F,Toyama Y

doi

10.1016/j.biomaterials.2004.03.038

keywords:

subject

Has Abstract

pub_date

2005-03-01 00:00:00

pages

1019-26

issue

eissn

0142-9612

issn

1878-5905

pii

S0142961204002960

journal_volume

pub_type

临床试验,杂志文章

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Screening for symptomatic metal sensitivity: a prospective study of 92 patients undergoing total knee arthroplasty.