title: Metal Hypersensitivity Reactions to Orthopedic Implants.
abstract: Total hip and knee replacement surgery using metal alloy devices is common. Type IV allergic reactions to these implants occur, though infrequently. While uncommon, peri-implant metal allergic reactions may cause significant morbidity for the affected individual-including aseptic loosening, pseudotumor formation and frank device failure. It is challenging to predict who will have these reactions, even in those with established pre-implant metal allergy. At this time, the scientific literature clearly supports few conclusions. Despite this, we believe several conclusions can be made: routine pre-implant testing in asymptomatic individuals is not indicated; listen to patient's concerns about metal allergy if the concern arises; patch testing is probably the best pre- and post-implant screening test; post-implantation testing is controversial and even positive LTT or patch test does not definitively diagnose morbidity from a metal allergy; and complete recovery following revision placement of an immunologically inert device is diagnostic. More research is needed to scientifically approach this issue.
authors.affiliation: Department of Surgery (Dermatology), Geisel School of Medicine at Dartmouth, Hanover, NH, USA.
authors.forename: Wendy Z W
authors.initials: WZW
authors.lastname: Teo
authors.affiliation: Department of Surgery (Dermatology), Geisel School of Medicine at Dartmouth, Hanover, NH, USA. schalock.prof@gmail.com.
authors.forename: Peter C
authors.initials: PC
authors.lastname: Schalock
keywords: Metal allergy; Orthopedic implants; Patch testing