Stathopoulos Ioannis P, Andrianopoulos Nicolaos, Paschaloglou Dimitrios, Tsarouchas Ioannis
Orthopaedic Department, Athens Medical Center, 56, Kifisias ave and Delfon, 15125, Amaroussio, Athens, Greece.
Arch Orthop Trauma Surg. 2017 Feb;137(2):267-271. doi: 10.1007/s00402-016-2614-6. Epub 2017 Jan 9.
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.
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.
Full disappearance of the symptoms occurred 3 months after revision. The latest follow-up evaluation (3 years post-revision) was unremarkable.
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.
对植入物过敏是全膝关节置换术（TKA）一种罕见的并发症。金属，以及较少见的骨水泥，可引发过敏症状，若保守治疗无效则可能导致翻修手术。
我们报告一例患者，在TKA术后第一个月开始出现全身瘙痒和金属味觉。皮肤过敏检查显示该患者对硫酸镍、氯化钴和骨水泥过敏。使用抗组胺药物和皮质类固醇进行的保守治疗未能控制症状。该患者在初次手术后8个月接受了使用低过敏性假体的翻修TKA手术。
翻修手术后3个月症状完全消失。最新的随访评估（翻修后3年）未见异常。
我们认为，对于每一位全关节置换术候选人都应详细询问病史，对于既往对金属、塑料或胶水有严重过敏反应的患者，应对未来假体的组件进行斑贴试验。当已植入的假体引起疼痛、水肿、瘙痒、红斑、活动范围受限和关节温度升高等症状时，在排除感染等其他原因后，应检查对金属和/或骨水泥（对于骨水泥固定假体的情况）过敏的可能性。如果症状无法通过保守措施控制，应决定进行翻修，并使用低过敏性假体。
