King, SW, Royeca, JM, Cunningham, CM et al. (3 more authors) (2020) Metal hypersensitivity in total knee arthroplasty. Journal of Arthroscopy and Joint Surgery, 7 (4). pp. 184-188. ISSN 2214-9635
Abstract
Metals used in total knee arthroplasty cause hypersensitivity reactions in some patients. These reactions are known to be immune-mediated and are more likely to affect individuals with pre-existing metal sensitivity, but their mechanism is not fully known. It is difficult to predict pre-operatively whether a patient will be affected and there is no reliable investigation to guide implant choice. There appears to be little value in screening all patients for metal sensitivity before implantation as various studies have shown no significant difference in outcomes or failure rates post TKA in patients with history of metal sensitivity. However, the existing assessment tools are not specific enough to identify subtle problems with potential metal sensitivity association.
Symptoms of hypersensitivity reactions following total knee arthroplasty are often non-specific and difficult to differentiate from other acute presentations following total knee arthroplasty, for example infection. Metal hypersensitivity reactions are often a diagnosis of exclusion, and for this reason they are most likely under-diagnosed and under-reported. Management is controversial but periprosthetic hypersensitivity reactions will often ultimately require revision if no other cause is found. Metal debris are a concern in total hip arthroplasty and could represent another cause of metal-related pathology in total knee arthroplasty. Non-metallic materials are currently in development which may represent a preventative solution for metal hypersensitivity reactions in total knee arthroplasty, potentially also addressing additional concerns around the use of metallic implants such as the high density and thermal conductivity of the material in comparison with the replaced tissue.
Metadata
Item Type: | Article |
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Authors/Creators: |
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Copyright, Publisher and Additional Information: | © 2020 Published by Elsevier, a division of RELX India, Pvt. Ltd on behalf of International Society for Knowledge for Surgeons on Arthroscopy and Arthroplasty. This is an author produced version of an article published in Journal of Arthroscopy and Joint Surgery . Uploaded in accordance with the publisher's self-archiving policy. |
Keywords: | Immune-mediated; Metal hypersensitivity; Periprosthetic; Total knee arthroplasty |
Dates: |
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Institution: | The University of Leeds |
Academic Units: | The University of Leeds > Faculty of Medicine and Health (Leeds) > School of Medicine (Leeds) > Institute of Rheumatology & Musculoskeletal Medicine (LIRMM) (Leeds) > Orthopaedics (Leeds) |
Depositing User: | Symplectic Publications |
Date Deposited: | 28 Oct 2020 13:11 |
Last Modified: | 27 Jun 2022 13:36 |
Status: | Published |
Publisher: | Elsevier |
Identification Number: | 10.1016/j.jajs.2020.09.004 |
Open Archives Initiative ID (OAI ID): | oai:eprints.whiterose.ac.uk:167192 |