With the increasing amount of joint replacement surgeries taking place, allergists are seeing patients with metal hypersensitivity.
A significant amount of patients have metal sensitivity and may react to their prothesis. These patients will need to be referred for allergy testing to help determine which material is triggering their reaction.
Materials commonly used in total joint replacements are Cobalt, Chromium, Molybdenum, Nickel, Tungsten, Manganese, Titanium, Aluminum and Vanadium.
All metals in contact with the biological system undergo corrosion. This can elicit hypersensitivity reactions.
In general 10-15% of the population have metal hypersensitivity. There is conflciting evidence as to whether sensitivity to implanted metals increase after joint replacement and whether this metal sensitivity causes patients to have a higher likelihood of joint implant failure.
These patients can present with pain, joint effusions and dislocations. Skin manifestations can be erythema, swelling, papules and vesicles.
Patch testing is considered the best method for diagnosing contact allergy. Standard TRUE patch testing though may miss all possible metals being used for replacement surgery. The major ingredients needed are Nickel, Cobalt and Chomimum. But every joint may be different and some experts recommend many more metals.
Overall patients who report a history of metal allergy should be considered for delayed type hypersensitivity testing before surgery. Positive testing may guide surgeons to consider implants with minimal amounts of metal.