Hypersensitivity or allergy can occur after contact with various metals. Titanium has also been reported as an allergen in a few studies, causing type I or type IV hypersensitivity reactions [3]. If that includes you, make sure your healthcare provider knows. Retained foreign bodies (RFB) are also possible complications of any surgical procedure. However, in some patients, hardware can become prominent or irritate a nearby . 2010 Mar;61(3):255-62; quiz 263-4. doi: 10.1007/s00105-009-1907-x. It is estimated that up to 17% of women and 3% of men are nickel allergic, and that about 1 to 2% are allergic to cobalt, chromium, or both. J Allergy Clin Immunol Pract. The skin (or other tissue) that comes in contact with the offending metal becomes red, itchy, and irritated. Titanium is extensively used in devices such as dental implants, pacemakers, and body piercing. Orthopade. Revision to titanium THR with ceramic-on-ceramic bearing led to symptom resolution. > 1 stenosis = 60 (case) 1 stenosis = 68 (control), Bare metal stainless steel 316L stents; 19% (24/128) of all patients were nickel positive; "24 nickel positives, 30% in study group, 9% in control group (, Multivariate analysis: most significant predictor of chronic in-stent restenosis: reference vessel diameter (. This is why it is important to exclude all other causes of joint inflammation and pain before exploring the next step in treatment: revision surgery. It may be necessary to remove the spinal hardware to avoid any further complications. led to symptom resolution; awaiting revision on other side. The Dr really should check it. On this site, Dr. Sinicropi periodically provides assessments and commentary on specific procedures that individuals have undergone. 2, 2020. In essence, hypersensitivity reactions become a diagnosis of exclusion for physicians. Disclaimer. Epub 2018 Apr 16. However, we suggest that pre-implant patients should be asked about a history of hypersensitivity reactions to metals, and patch testing should be recommended to patients who have experienced such reactions. G. Tawil, P. Tawil, and C. Irani, Zirconium implant as an alternative to titanium implant in a case of type IV titanium allergy: case report, The International Journal of Oral & Maxillofacial Implants, vol. 2023 Feb 2;11:1140393. doi: 10.3389/fbioe.2023.1140393. MeSH Multiple cardiac and neurostimulatory devices are constructed of metals and adhesives that can be sensitizing in some individuals. She was tested for Clostridium difficile infection and showed positive toxin B results confirming the diagnosis. eCollection 2022 Oct. [Orthopedic surgical implants and allergies: joint statement by the implant allergy working group (AK 20) of the DGOOC (German association of orthopedics and orthopedic surgery), DKG (German contact dermatitis research group) and dgaki (German society for allergology and clinical immunology)]. These allergens are also the most important in reactions to spinal surgeries. Allergy in total knee replacement surgery: Is it a real problem? 1, pp. Biomaterial scaffolds regulate macrophage activity to accelerate bone regeneration. 2017;13(1):129. 1, pp. Please enter a Recipient Address and/or check the Send me a copy checkbox. The skin patch test has not yet been developed as the valid standardized test for titanium allergy. 2016;98-B(4):437-41. doi:10.1302/0301-620X.98B4.36767, Teo WZW, Schalock PC. Most skin reactions are eczematous and allergic in nature, although urticarial, bullous, and vasculitic eruptions may occur. Many people have known skin sensitivities to various metals. During the cholecystectomy, six titanium surgical clips were placed in the RUQ. Still, cases have been reported, and some people's symptoms have gone away after removal. 2019;10(2):63-70. doi:10.5312/wjo.v10.i2.63, Kahlenberg CA, Nwachukwu BU, McLawhorn AS, Cross MB, Cornell CN, Padgett DE. The https:// ensures that you are connecting to the [4] In some countries, a significant proportion of metal allergy derives from occupational exposure in the metal and construction industries. Bookshelf Diagnosing any metal allergy, including titanium allergy, has been complicated by various tests sensitivity and specificity. Dermatol Ther (Heidelb). Craig Payne said: . The woman also had a cholecystectomy back in 2007, and thats when she began experiencing symptoms including joint pain and tenderness, cramps, dry skin and hair, racing heart, hand tremors, and high blood pressure, among many others. 2022 Aug 8;17(8):e0272283. This article discusses knee replacement metal allergies and sensitivities. Middleton S, Toms A. Metal Allergy/Sensitivity Symptoms Symptoms of an allergy or sensitivity to metal in a knee replacement include: 7 Chronic (persistent) knee pain Chronic or intermittent knee redness, warmth, and swelling Knee stiffness and reduced range of motion Itchy, scaly skin patches around the affected joint Reactions to metals in knee replacements happen when the immune system overreacts or launches a defensive assault on the artificial joint and surrounding tissues, triggering local inflammation. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. Particularly for implants placed in the upper jaw, sinus problems may . Allergic reactions occur when a substance triggers an immune response. Severe skin rashes. 2016 Sep;31(9):1910-5. Materials (Basel). 2013 ;55(1-3):83-90. doi:10.1007/s12026-012-8351-1, Schoon J, Ort MJ, Huesker K, Geissler S, Rakow A. While the potential for a reaction exists, it's thought to be extremely low. Her symptoms became chronic and progressed further to abdominal distension with increasing abdominal girth, fever, and several episodes of watery diarrhea. "Patient-ReportedMetalAllergy: A Risk Factor for Poor Outcomes After Total JointArthroplasty?" Most reactions to knee replacements are hypersensitive reactions. The patient initially presented to the clinic with an intermittent right upper quadrant (RUQ) pain in 2016. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. Allergy in total knee replacement. *List is not exhaustive. Shortness of breath. Pain around the site of orthopedic implants has many causes. The CT scan showing a portion of the pigtail catheter lodged within the cecum in a coronal view (a), sagittal view (b), and axial view (c). Read our. A few studies have also reported titanium as a potential allergen. The surgical pathology report for the removed catheter specified foreign body consisting of synthetic stent measuring 10.0cm in length and 0.3cm in diameter (Figure 4). Click to share on Facebook (Opens in new window), Click to share on Twitter (Opens in new window), Click to share on LinkedIn (Opens in new window), Click to email a link to a friend (Opens in new window), Two Level Cervical Disc Replacement (Mobi-C). chronic inflammation in the gums around the implant. But sometimes issues do arise. With that said, some studies suggest that they may be beneficial for certain groups. Seminal studies cited by the International Journal of Implant Dentistry report that titanium allergy symptoms include: Erythema (skin redness, in this case, in the tissues around the implant) Urticaria (hives that may be seen on the skin or gum surface) Eczema (itchy inflammation of the skin or gum tissue) Swelling or pain Co-Cr-Mo = cobalt-chromium-molybdenum; LCS = low contact stress; MOM = metal-on-metal; PMMA = polymethylmethacrylate; pts = patients; Ref. There are many things that could be causing the healing. 2019 Nov;10:02758. doi:10.3389/fimmu.2019.02758, Faschingbauer M, Renner L, Boettner F. Allergy in total knee replacement. Allergic reactions can range from mild to severe. A rash after surgery may be due to contact with irritants or an allergic reaction to a medication. Nickel, cobalt, and chromium are the three most common metals that elicit both cutaneous and extracutaneous allergic reactions from chronic internal exposure. The patient contacted our department the next morning, and the case and CT findings were reviewed. Injury to the Teeth, Blood Vessels and Nerves. In an aging population, the putative association between metal allergy and device failure due to DTH may be a problem of growing significance. If you notice any severe symptoms after your spine surgery, be sure to contact your surgeon. Within a few days, she started having vomiting, bloating, weakness, fatigue, and intense RLQ abdominal pain. Runny nose. Proper examination of medical and surgical histories are important, as well as physical examinations such as metal allergy testing, as this can help determine the technique and medical equipment to be used during the procedure. Discussion This review provides an update of the current knowledge in this field and should be valuable to health care providers who manage patients with conditions related to this field. can be made from various materials, such as: The brief answer to our initial question is yes, patients can be allergic to hardware if they have a pre-existing allergy to the materials that make up the hardware (titanium, stainless steel, etc.). The patient was referred to an infectious disease specialist and kept on a course of oral vancomycin and fidaxomicin. The .gov means its official. LTT is another more sensitive test than the skin-patch test; however, there are reports of some false-positive results [3]. After the diagnosis of RFB, the preferred approach is to remove the RFB laparoscopically [13]. 62, no. Please confirm that you would like to log out of Medscape. Case presentation We present the case of a 52-year-old female patient with reoccured low back pain and sciatica after posterior lumbar decompression and fusion (PLDF) for her lumbar . These degradation products of the implant may cause increased metal hypersensitivity and implant failure. None had issues despite confirmed allergy to one of the metals in their device (6-year follow-up). Highest odds ratio for restenosis (5.41) were in nickel positives. The pain was sharp and stabbing in nature and radiated from the umbilicus, and the patient rated the pain 10/10 on a scale, causing her significant discomfort. Between 10% and 15% of the general population is sensitive or allergic to nickel. doi:10.1007/s11420-018-9614-8, Mayer AS, Erb S, Kim RH, et al. sores and swelling in the soft tissues of the mouth. -, J Bone Joint Surg Am. Having a metal allergy or sensitivity doesn't mean getting a metal implant like a surgical screw, plate, or joint replacement is entirely off limits or that the body will reject it. 2023 Dr. Stefano Sinicropi The information contained on this site is intended to provide only general education about spine surgery and conditions. Vomiting or diarrhea. Plaintiffs claim that they have suffered from serious injuries during or after a surgery because of misfired staples from a defective surgical stapler. Blog swelling. eCollection 2022. Dermatitis. These screws normally contain 14% nickel, 20% . Careers. Late onset infection can occur in some cases where you have some focus of infection causing bacteremia,and the sign symptoms include, redness. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. If you have an allergy or sensitivity to metals, ask your surgeon about knee replacements made with hypoallergenic materials. Prospective: 171 total stents; in-stent restenosis in 100% of patients with positive patch-test result but in only 57% of patients with negative patchtest results; no control group; only significant differences were for nickel and molybdenum. Hay fever, also called allergic rhinitis, can cause . = reference; THA = total hip arthroplasty; THR = total hip replacement. 2023 Mar 20;16(6):2463. doi: 10.3390/ma16062463. It's rare for someone to need their metal implants removed due to a metal allergy or sensitivity. 155162, 1999. Patients can present with atopic dermatitis, pruritus, edema, urticaria, impaired healing fractures, pain, and necrosis of implants [ 3 ]. eCollection 2023. If you have a known hypersensitivity to metal and are scheduled to undergo a total knee replacement, it is not clear if starting with a ceramic or titanium appliance is the best option. Okamura et al. eCollection 2023 Jun. The authors declare that they have no competing interests. With prosthetic knees, stainless steel used to build the appliance contains around 10% nickel. Will my hardware set off a metal detector? However, in October 2020, the patient started having new symptoms of watery, nonbloody diarrhea associated with her chronic RLQ pain. Fortunately, allergic responses to surgical implants are infrequent. 15, 2019. It also sheds light on retained foreign bodies as a possible cause of abdominal pain in patients who have gone through various surgical procedures in the past. Edina, Bethesda, MD 20894, Web Policies The most important allergens in this category include nickel, cobalt, chromium, and bone cement. 2011;22(2):65-79. Changed to titaniumplated endoprostheses; symptoms resolved. July 9, 2021/ Erica Davies / Surgical Stapler Lawsuit / 0 comments. The most common symptoms of hypersensitivity to metals include: A small and localized hypersensitivity reaction can appear as a contact dermatitis where the skin may appear red, itchy, and swollen, sometimes accompanied with rashes and hives. Copyright 2016 The Authors. These cookies will be stored in your browser only with your consent. doi:10.1007/s11420-016-9514-8. We also use third-party cookies that help us analyze and understand how you use this website. 2001 Apr 14;357(9263):1205-6; author reply 1206-7 It helps to understand what happens when your body comes in contact with a metal to which you're allergic. National Library of Medicine Allergic responses to metals such as nickel, chromium, mercury, cobalt, and gold are widely recognized [1]. Before blame can be assigned to metal sensitivity or allergy, a thorough investigation must occur. The striking features of titanium include its stability with increased resistance to corrosion and its biocompatibility to diverse materials [3]. The patients past surgical history includes a tonsillectomy, an appendectomy, and cholecystectomy. Metal allergies are referred to as delayed-type hypersensitivity (DHT). Moreover, the patient was under multiple specialists care and had many hospitalizations and a history of various medication intake, including antibiotics and painkillers. A more severe hypersensitivity reaction is usually due to prolonged exposure to a metal allergen, which is possible through metal implants used in surgeries or metal ions that are ingested or inhaled. These cookies do not store any personal information. If you have any of these symptoms, you may wish to speak to a doctor to discuss the possibility of having hypersensitivity reactions. HHS Vulnerability Disclosure, Help Learn about the causes, diagnosis, symptoms, treatment, and more. If surgery is needed, the implant would be removed and replaced with a special implant made of ceramic or titanium. All of which have resulted in complications that may either occur during the surgical procedure, or may only show up days after the surgery. M. Tu and Y. Wu, Multiple allergies to metal alloys, Dermatologica Sinica, vol. Bethesda, MD 20894, Web Policies The titanium screws used in the orthopedic surgery that he underwent were removed 1 year later, but the eczema remained. She reported symptoms including a low-grade fever, nausea, vomiting, diarrhea, and joint pain. 3, pp. The CT impressions showed no signs of bowel obstruction or colitis; however, it was evident that a portion of a pigtail drainage catheter was lodged within the cecum (Figure 2). Healthcare providers now believe that the term, "iodine allergy" should no longer be used because it is inaccurate. The MELISA test has been known to be a more sensitive test to metal allergy but lacks specificity in the proliferation of lymphocytes [3]. Implant-related Allergic Contact Dermatitis, Cobalt-chromiummolybdenum steel (ASTM F75), 1. J Prosthet Dent. Titanium: a review on exposure, release, penetration, allergy, epidemiology, and clinical reactivity. Federal government websites often end in .gov or .mil. Your healthcare provider can help you determine the cause of your problems and the appropriate treatment to consider. Immune response differences in degradable and non-degradable alloy implants. [1] Metal allergy is mainly caused by prolonged or repeated skin exposure to consumer items such as jewelry, cell phones,[2] clothing fasteners,[3] and leather goods. We discuss the presentation, investigations, and treatment of this unusual case. Signs and symptoms of metal hypersensitivity can range from mild to severe and generalized. Revision to a ceramic-on-ceramic THR led to symptom resolution. apr18 1, article bcr2013009070, 2013. The patient had undergone a laparoscopic removal of the eight clips used in her past surgery, and since then, her symptoms have resolved. fibromyalgia (widespread pain without known cause). Cross-sectional observational study exploring clinical risk of titanium allergy caused by dental implants. Eczema most severe around the implant site, 3. The https:// ensures that you are connecting to the After removal of dental implants, the eczema disappeared completely. The joint never fully fused and I had the stainless steel replaced first with a single titanium screw and cadaver bone graft and then a third . sharing sensitive information, make sure youre on a federal Because this can involve another surgery that may be quite complicated, it should not be done without a thorough review of the pros and cons. An Investigation into the Potential of Turning Induced Deformation Technique for Developing Porous Magnesium and Mg-SiO. Co = cobalt; Cr = chromium; Mo = molybdenum; Ni = nickel. By Jonathan Cluett, MD The patient recovered well with no significant intraoperative or postoperative complications. 4, pp. If you or a loved one have any of these latter, more severe symptoms, these are indicators of when to go to the ER for an allergic reaction . Fortunately, allergic responses to surgical implants are infrequent. Metal Allergy to Surgical Plates, Screws, and Implants. But while reactions to surgical hardware and implants are rare, they do sometimes occur. The abdominal pain is associated with titanium allergy reaction from previously inserted titanium-based surgical clips. Medicines to avoid in pregnancy JArthroplasty. FOIA In most instances, these screws and plates do not create symptoms and remain permanently in the foot. Health care providers have been known to rely more on staples in performing surgeries. There is no data to support the routine use of ceramic (zirconium) or titanium implants, even in people with concerns about metal hypersensitivity. 2016;24(2):106112. The patient started having another episode of intermittent right lower quadrant (RLQ) pain starting in January 2020. of weight loss in only four months of duration. This article explores metals commonly used in medical devices, possible sensitivities and allergies, symptoms that may occur with a metal allergy, and when removal may be recommended. Large periprosthetic cystic mass removed surgically. An allergic reaction can crop up in the form of headaches, pain in the back and extremities, fever, and other symptoms. Staples are used to hold skin together in order to clsoe a surgical incision or wound that is too big or complex to close with traditional sutures or stitches. Allergy symptoms, which depend on the substance involved, can affect your airways, sinuses and nasal passages, skin, and digestive system. *List is not exhaustive. This makes it an adequate metal of choice for intraosseous use in medical procedures. The most common symptoms for patients with MHS-associated failures are localized soft tissue reaction including delayed wound healing and/or recurrent wound issues. 12, no. American Association of Hip and Knee Surgeons. This website also contains material copyrighted by 3rd parties. When they do occur, titanium allergy symptoms can range from mild to severe and can include: loosening of the implants (or implant failure) rash or hives. Total knee arthroplasty (TKA) is generally a very successful surgery, and the vast majority of people who undergo it are satisfied with the results. Moreover, titanium has been described to activate macrophages through phagocytosis to cause the release of pro- and anti-inflammatory cytokines [9]. Thank you, {{form.email}}, for signing up. 5761, 1999. People with suspected metal allergies or sensitivities should undergo testing prior to knee replacement surgery. Department of Medicine, Section of Dermatology, The University of Chicago, Chicago, IL; the National Allergy Research Centre, Department of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, Denmark; and the Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA. If you notice any severe symptoms after your spine surgery, be sure to contact your surgeon. Sun et al., Suspected allergy to titanium after anterior cervical discectomy and fusion using a Zero-P device: a case report, British Journal of Neurosurgery, pp. The patient has been recommended to do a close follow-up for a few months to monitor her progress. Conclusions: Nasal congestion. C. Shi, Y. Xi, B. It is important to diagnose RFB promptly and remove it as soon as possible due to life-threatening complications such as gastrointestinal bleeding, intestinal obstruction, and perforation [13]. A number of studies also suggest a conversion to suturing in place of surgical stapling in order to avoid allergic reactions and other potential complications after surgery. Titanium is used not only for medical applications such as plastic surgery and/or dental implants, but also for paints, white pigments, photocatalysts, and various types of everyday goods. By clicking Accept, you consent to the use of ALL the cookies. Y. Nakashima, D. H. Sun, M. Trindade, W. Maloney, S. Goodman, and D. Schurman, Induction of macrophage C-C chemokine expression by titanium alloy and bone cement particles, Journal of Bone and Joint Surgery, vol. Telephone: 1.800.234.1826 ", < 1% develop cutaneous reactions versus 2025% of patients who develop implant-induced metal sensitivity without any allergic skin manifestations.
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