title: Metal hypersensitivity in total joint arthroplasty.
abstract: OBJECTIVE
  To review the clinical manifestations, testing methods, and treatment options for hypersensitivity reactions to total joint arthroplasty procedures.
  
  
  METHODS
  Studies were identified using MEDLINE and reference lists of key articles.
  
  
  METHODS
  Randomized controlled trials were selected when available. Systematic reviews and meta-analyses of peer-reviewed literature were included, as were case series and observational studies of clinical interest.
  
  
  RESULTS
  Total joint arthroplasty procedures are increasing, as are the hypersensitivity reactions to these implants. Evidence is not conclusive as to whether metal joint implants increase metal sensitivity or whether metal sensitivity leads to prosthesis failure. Currently, patch testing is still the most widely used method for determining metal hypersensitivity; however, there are no standardized commercial panels specific for total joint replacements available currently. In vitro testing has shown comparable results in some studies, but its use in the clinical setting may be limited by the cost and need for specialized laboratories. Hypersensitivity testing is generally recommended before surgery for patients with a reported history of metal sensitivity. In cases of metal hypersensitivity-related joint failure, surgical revision ultimately may be required. Knowledge about joint replacement hypersensitivity reactions becomes vital because the approach to the evaluation depends on appropriate testing to guide recommendations for future arthroplasty procedures.
  
  
  CONCLUSIONS
  Evaluation of hypersensitivity reactions after total joint arthroplasty requires a systematic approach, including a careful history, targeted evaluation with skin testing, and in vitro studies.
authors.affiliation: Department of Medicine, Allergy/Immunology Division, Wilford Hall Ambulatory Surgical Center, San Antonio, Texas. Electronic address: michelle.pinson.1@us.af.mil.
authors.forename: Michelle L
authors.initials: ML
authors.lastname: Pinson
authors.affiliation: Department of Medicine, Allergy/Immunology Division, Wilford Hall Ambulatory Surgical Center, San Antonio, Texas.
authors.forename: Christopher A
authors.initials: CA
authors.lastname: Coop
authors.affiliation: Department of Medicine, Allergy/Immunology Division, Wilford Hall Ambulatory Surgical Center, San Antonio, Texas.
authors.forename: Charles N
authors.initials: CN
authors.lastname: Webb
mesh_terms: D001178:Arthroplasty / Q000009:adverse effects*; D006801:Humans; D006967:Hypersensitivity / Q000175:diagnosis / Q000276:immunology*; D061825:Metal-on-Metal Joint Prostheses / Q000009:adverse effects*; D008670:Metals / Q000009:adverse effects / Q000097:blood / Q000276:immunology*; D011475:Prosthesis Failure
chemical_list: D008670:Metals