Department of Orthopedic Surgery, Institute of Musculoskeletal Surgery, University of Pécs Clinical Center, 1 Akác utca, Pécs 7632, Hungary.
J Orthop Surg Res. 2013 May 16;8:12. doi: 10.1186/1749-799X-8-12.
The aim of the study was to examine the reactivity of peripheral human leukocytes to various metal ions prior and following hip replacement in order to investigate implant-induced metal sensitivity.
Three patient groups were set up: (1) individuals without implants and no history of metal allergy (7 cases), (2) individuals without implants and known history of metal allergy (7 cases), and (3) patients undergoing cementless hip replacement (40 cases). Blood samples were taken in groups 1 and 2 at three different occasions; in group 3, prior and 3, 6, 12, 24, and 36 months after surgery. Peripheral leukocytes were separated and left either untreated or challenged with Ti, NiCl₂, CoCl₂, CrCl₃, and phytohemagglutinin. Cell proliferation, cytokine release, and leukocyte migration inhibition assays were performed. Metal-induced reactivity was considered when all three assays showed significant change. Skin patch tests were also carried out.
Both skin patch tests and leukocyte functional tests were negative in group 1, and both were positive in group 2. In group 3, after 6 months, 12% of the patients showed reactivity to the tested metals except for NiCl2. Following the 36-month period, 18% of group three became sensitive to metals (including all the earlier 12%). In contrast, patch tests were negative at each time point in group 3.
Orthopedic implant material may induce metal reactivity after implantation in a manner where susceptibility is yet to be elucidated. Leukocyte triple assay technique might be a useful tool to test implant material-related sensitivity.
本研究旨在检测外周血人类白细胞对不同金属离子的反应性，以研究植入物诱导的金属敏感性。
设立了三组患者：（1）无植入物且无金属过敏史者（7 例），（2）无植入物且已知金属过敏史者（7 例），（3）进行非骨水泥髋关节置换术者（40 例）。在组 1 和组 2 中，在三个不同时间点采集血样；在组 3 中，在手术前以及术后 3、6、12、24 和 36 个月采集血样。分离外周白细胞，分别进行未处理和用 Ti、NiCl₂、CoCl₂、CrCl₃和植物血球凝集素刺激。进行细胞增殖、细胞因子释放和白细胞迁移抑制试验。当所有三种试验均显示明显变化时，认为存在金属诱导的反应性。还进行了皮肤斑贴试验。
组 1 的皮肤斑贴试验和白细胞功能试验均为阴性，组 2 均为阳性。在组 3 中，在 6 个月后，除 NiCl₂外，12%的患者对测试金属有反应。在 36 个月后，18%的组 3 患者对金属敏感（包括所有早期的 12%）。相比之下，在组 3 中的每个时间点，皮肤斑贴试验均为阴性。
骨科植入物材料在植入后可能以尚未阐明的方式引起金属反应性。白细胞三联检测技术可能是一种有用的工具，用于检测植入物材料相关的敏感性。
