title: Revision total knee arthroplasty due to bone cement and metal hypersensitivity.
abstract: BACKGROUND
  Hypersensitivity to implants is a rare complication of total knee arthroplasty (TKA). Metal and, less frequently, bone cement can produce allergic symptomatology that if unresponsive to conservative treatment could lead to revision.
  
  
  METHODS
  We present the case of a patient with generalized pruritus and metal taste starting during the first postoperative month after TKA. Dermal allergy exams revealed that the patient had hypersensitivity to nickel sulphate and cobalt chloride and bone cement. Conservative treatment with antihistamine medication and corticosteroids failed to control the symptoms. The patient underwent revision TKA with a hypoallergic prosthesis 8 months after the primary procedure.
  
  
  RESULTS
  Full disappearance of the symptoms occurred 3 months after revision. The latest follow-up evaluation (3 years post-revision) was unremarkable.
  
  
  CONCLUSIONS
  In our opinion, an exhaustive medical history should be obtained from every candidate for total joint replacement and in cases of prior severe allergic reactions to metals, plastics or glues, patch testing of the components of the future prosthesis should be done. When an already implanted prosthesis causes symptoms like pain, edema, pruritus, erythema, limited range of motion and increase in joint's temperature, the possibility of allergy to metals and/or bone cement (in case of cemented prosthesis) should be checked after the exclusion of other reasons like infection. If symptoms cannot be controlled by conservative measures, revision should be decided and carried out with hypoallergic prosthesis.
authors.affiliation: Orthopaedic Department, Athens Medical Center, 56, Kifisias ave and Delfon, 15125, Amaroussio, Athens, Greece. ipstathopoulos@gmail.com.
authors.forename: Ioannis P
authors.initials: IP
authors.lastname: Stathopoulos
authors.affiliation: Orthopaedic Department, Athens Medical Center, 56, Kifisias ave and Delfon, 15125, Amaroussio, Athens, Greece.
authors.forename: Nicolaos
authors.initials: N
authors.lastname: Andrianopoulos
authors.affiliation: Orthopaedic Department, Athens Medical Center, 56, Kifisias ave and Delfon, 15125, Amaroussio, Athens, Greece.
authors.forename: Dimitrios
authors.initials: D
authors.lastname: Paschaloglou
authors.affiliation: Orthopaedic Department, Athens Medical Center, 56, Kifisias ave and Delfon, 15125, Amaroussio, Athens, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Tsarouchas
mesh_terms: D000368:Aged; D019645:Arthroplasty, Replacement, Knee / Q000009:adverse effects*; D001843:Bone Cements / Q000009:adverse effects*; D005260:Female; D006801:Humans; D006967:Hypersensitivity / Q000209:etiology / Q000601:surgery*; D007720:Knee Prosthesis / Q000009:adverse effects*; D008670:Metals / Q000008:administration & dosage*; D012086:Reoperation
chemical_list: D001843:Bone Cements; D008670:Metals
keywords: Bone cement; Cobalt; Hypersensitivity; Nickel; Total knee arthroplasty