title: Allergic reactions in arthroplasty: myth or serious problem?
abstract: OBJECTIVE
  The purpose of this study was to determine the prevalence of sensitisation to chromium, cobalt, nickel, or a cement component in patients who received endoprosthetic surgery at our institution. Also, we aimed to assess the portion related to allergic reactions in endoprosthetic revisions and to follow-up those patients after allergic reaction related revisions.
  
  
  METHODS
  We selected patients with a pre-operative known sensitisation to chromium, cobalt, nickel, or a cement component for a post-operative allergic reaction. All patients who received revision surgery because of a potential allergic reaction were followed up post revision surgery.
  
  
  RESULTS
  Eight hundred fifty-five patients were pre-operative known to have a sensitisation to chromium, cobalt, nickel, or a cement component. Six hundred eighty-two patients (79.8 %) received a primary arthroplasty, and 173 patients (20.2 %) received a revision surgery. Seventeen patients (2.0 %) were revised because of allergic reactions. Allergic reactions were the cause for approximately 0.2 % of all endoprosthetic revisions and for 9.8 % of revisions in patients with sensitisation to one of the reviewed components. Potential allergens were strictly avoided in the replaced prosthesis. Outcome scores improved post-operatively.
  
  
  CONCLUSIONS
  The allergic patient should be thoroughly informed about potential reactions resulting from implant choice. Our study can serve as risk assessments by quantifying the incidence of allergic reactions due to endoprosthetic treatment.
authors.affiliation: Orthopaedic Department, Helios-Endo Klinik Hamburg, Holstenstraße 9, 22767, Hamburg, Germany. guenther.daniel@mh-hannover.de.|Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany. guenther.daniel@mh-hannover.de.
authors.forename: Daniel
authors.initials: D
authors.lastname: Guenther
authors.affiliation: Department of Dermatology und Allergology, Ludwig Maximilian University of Munich, Frauenlobstraße 9-11, 80337, Munich, Germany.
authors.forename: Peter
authors.initials: P
authors.lastname: Thomas
authors.affiliation: Orthopaedic Department, Helios-Endo Klinik Hamburg, Holstenstraße 9, 22767, Hamburg, Germany.
authors.forename: Daniel
authors.initials: D
authors.lastname: Kendoff
authors.affiliation: Trauma Department, Hannover Medical School (MHH), Carl-Neuberg-Str. 1, 30625, Hannover, Germany.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Omar
authors.affiliation: Orthopaedic Department, Helios-Endo Klinik Hamburg, Holstenstraße 9, 22767, Hamburg, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Gehrke
authors.affiliation: Orthopaedic Department, Helios-Endo Klinik Hamburg, Holstenstraße 9, 22767, Hamburg, Germany.
authors.forename: Carl
authors.initials: C
authors.lastname: Haasper
mesh_terms: D000328:Adult; D000368:Aged; D019644:Arthroplasty, Replacement, Hip / Q000295:instrumentation*; D019645:Arthroplasty, Replacement, Knee / Q000295:instrumentation*; D001843:Bone Cements / Q000009:adverse effects*; D002857:Chromium / Q000009:adverse effects; D003035:Cobalt / Q000009:adverse effects; D017449:Dermatitis, Allergic Contact / Q000209:etiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D061825:Metal-on-Metal Joint Prostheses / Q000009:adverse effects*; D008670:Metals / Q000009:adverse effects*; D008875:Middle Aged; D009532:Nickel / Q000009:adverse effects; D015995:Prevalence; D012086:Reoperation
chemical_list: D001843:Bone Cements; D008670:Metals; D002857:Chromium; D003035:Cobalt; D009532:Nickel
keywords: Allergy; Arthroplasty; Immune reaction; Nickel; Prosthesis; Revision