title: Allergy to Surgical Implants.
abstract: Surgical implants have a wide array of therapeutic uses, most commonly in joint replacements, but also in repair of pes excavatum and spinal disorders, in cardiac devices (stents, patches, pacers, valves), in gynecological implants, and in dentistry. Many of the metals used are immunologically active, as are the methacrylates and epoxies used in conjunction with several of these devices. Allergic responses to surgical components can present atypically as failure of the device, with nonspecific symptoms of localized pain, swelling, warmth, loosening, instability, itching, or burning; localized rash is infrequent. Identification of the specific metal and cement components used in a particular implant can be difficult, but is crucial to guide testing and interpretation of results. Nickel, cobalt, and chromium remain the most common metals implicated in implant failure due to metal sensitization; methacrylate-based cements are also important contributors. This review will provide a guide on how to assess and interpret the clinical history, identify the components used in surgery, test for sensitization, and provide advice on possible solutions. Data on the pathways of metal-induced immune stimulation are included. In this setting, the allergist, the dermatologist, or both have the potential to significantly improve surgical outcomes and patient care.
authors.affiliation: Division of Environmental & Occupational Health Sciences, Department of Medicine, National Jewish Health, Denver, Colo; University of Colorado School of Public Health, Aurora, Colo. Electronic address: pachecok@njhealth.org.
authors.forename: Karin A
authors.initials: KA
authors.lastname: Pacheco
mesh_terms: D000368:Aged; D000485:Allergens / Q000276:immunology; D004852:Epoxy Compounds / Q000378:metabolism; D006801:Humans; D006967:Hypersensitivity / Q000150:complications / Q000276:immunology*; D008297:Male; D008670:Metals / Q000276:immunology; D008689:Methacrylates / Q000378:metabolism; D010328:Patch Tests; D017410:Practice Guidelines as Topic; D019736:Prostheses and Implants / Q000009:adverse effects / Q000706:statistics & numerical data*; D011475:Prosthesis Failure / Q000209:etiology; D019919:Prosthesis Implantation / Q000295:instrumentation*
chemical_list: D000485:Allergens; D004852:Epoxy Compounds; D008670:Metals; D008689:Methacrylates
keywords: Chromium: Bone cement; Cobalt; Joint replacements; Metal sensitization; Methacrylates; Nickel; Orthopedic implants; Patch testing