The association between metal allergy, total hip arthroplasty, and revision.
OBJECTIVE
It has been speculated that the prevalence of metal allergy may be higher in patients with implant failure. We compared the prevalence and cause of revisions following total hip arthroplasty (THA) in dermatitis patients suspected to have contact allergy and in patients in general with THA. Furthermore, we compared the prevalence of metal allergy in dermatitis patients with and without THA.


METHODS
The Danish Hip Arthroplasty Registry (DHAR) contained detailed information on 90,697 operations. The Gentofte patch-test database contained test results for patients suspected of having allergic contact dermatitis (n = 18,794). Cases (n = 356) were defined as patch-tested dermatitis patients who also had primary THA performed. Two age- and sex-matched controls (n = 712) from the patch-test database were sought for each case.


RESULTS
The prevalence of revision was similar in cases (12%) and in patients from the DHAR (13%). The prevalence of metal allergy was similar in cases and controls. However, the prevalence of metal allergy was lower in cases who were patch-tested after operation (6%) than in those who were patch-tested before operation (16%) (OR = 2.9; 95% CI = 1-8).


CONCLUSIONS
We found that the risk of surgical revision was not increased in patients with metal allergies and that the risk of metal allergy was not increased in cases who were operated, in comparison to controls. Despite some important study limitations, our observations add to the evidence that the risk of complications in metal allergic patients seems limited.
Thyssen
Jacob Pontoppidan
JP
National Allergy Research Centre, Department of Dermato-allergology, Gentofte Hospital, University of Copenhagen, Copenhagen. jacpth01@geh.regionh.dk
Jakobsen
Stig Storgaard
SS
Engkilde
Kåre
K
Johansen
Jeanne Duus
JD
Søballe
Kjeld
K
Menné
Torkil
T
D000293:Adolescent; D000328:Adult; D019644:Arthroplasty, Replacement, Hip / Q000009:adverse effects*; D016022:Case-Control Studies; D002648:Child; D002857:Chromium / Q000009:adverse effects; D003035:Cobalt / Q000009:adverse effects; D003718:Denmark / Q000453:epidemiology; D017449:Dermatitis, Allergic Contact / Q000150:complications* / Q000175:diagnosis / Q000453:epidemiology; D005260:Female; D006622:Hip Prosthesis / Q000009:adverse effects*; D006801:Humans; D008297:Male; D008670:Metals / Q000009:adverse effects*; D008875:Middle Aged; D009532:Nickel / Q000009:adverse effects; D010328:Patch Tests; D015995:Prevalence; D011474:Prosthesis Design; D011475:Prosthesis Failure; D012042:Registries; D012086:Reoperation; D012307:Risk Factors; D055815:Young Adult
D008670:Metals; D002857:Chromium; D003035:Cobalt; D009532:Nickel