title: Metal hypersensitivity testing in patients undergoing joint replacement: a systematic review.
abstract: We report a systematic review and meta-analysis of the peer-reviewed literature focusing on metal sensitivity testing in patients undergoing total joint replacement (TJR). Our purpose was to assess the risk of developing metal hypersensitivity post-operatively and its relationship with outcome and to investigate the advantages of performing hypersensitivity testing. We undertook a comprehensive search of the citations quoted in PubMed and EMBASE: 22 articles (comprising 3634 patients) met the inclusion criteria. The frequency of positive tests increased after TJR, especially in patients with implant failure or a metal-on-metal coupling. The probability of developing a metal allergy was higher post-operatively (odds ratio (OR) 1.52 (95% confidence interval (CI) 1.06 to 2.31)), and the risk was further increased when failed implants were compared with stable TJRs (OR 2.76 (95% CI 1.14 to 6.70)). Hypersensitivity testing was not able to discriminate between stable and failed TJRs, as its predictive value was not statistically proven. However, it is generally thought that hypersensitivity testing should be performed in patients with a history of metal allergy and in failed TJRs, especially with metal-on-metal implants and when the cause of the loosening is doubtful.
authors: Rizzoli Orthopaedic Institute, Laboratory for Orthopaedic Pathophysiology and Regenerative Medicine, Via di Barbiano 1/10, 40136 Bologna, Italy. donatella.granchi@ior.it
authors: D
authors: D
authors: Granchi
authors: E
authors: E
authors: Cenni
authors: A
authors: A
authors: Giunti
authors: N
authors: N
authors: Baldini
mesh_terms: D019643:Arthroplasty, Replacement / Q000009:adverse effects*; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis* / Q000209:etiology; D007595:Joint Prosthesis / Q000009:adverse effects*; D008670:Metals / Q000009:adverse effects*; D057234:Preoperative Period; D011475:Prosthesis Failure; D012882:Skin Tests / Q000379:methods
chemical_list: D008670:Metals