Metal hypersensitivity in total hip and knee arthroplasty: Current concepts

Abstract

Metal hypersensitivity (MHS) is a rare complication of total joint arthroplasty that has been linked to prosthetic device failure when other potential causes have been ruled out. The purpose of this review was to conduct an analysis of existing literature in order to get a better understanding of the pathophysiology, presentation, diagnosis, and management of MHS. It has been described as a type IV hypersensitivity reaction to the metals comprising prosthetic implants, often nickel and cobalt-chromium. Patients suffering from this condition have reported periprosthetic joint pain and swelling as well as cutaneous, eczematous dermatitis. There is no standard for diagnosis MHS, but tests such as patch testing and lymphocyte transformation testing have demonstrated utility, among others. Treatment options that have demonstrated success include administration of steroids and revision surgery, in which the existing metal implant is replaced with one of less allergenic materials. Moreover, the definitive resolution of symptoms has most commonly required revision surgery with the use of different implants. However, more studies are needed in order to understand the complexity of this subject.

Keywords: Metal allergy; Metal hypersensitivity; Total hip arthroplasty; Total joint arthroplasty; Total knee arthroplasty.

Fig. 1

Diagnostic algorithm for metal hypersensitivity (adapted from Mitchelson et al.⁶).

Fig. 2

Metal hypersensitivity treatment algorithm (adapted from Mitchelson et al.⁶).