Peat Fidel, Coomber Ross, Rana Adnan, Vince Alastair
Department of Trauma and Orthopaedics, Addenbrooke's Hospital, Cambridge, UK.
Trauma and Orthopaedics, Luton and Dunstable University Hospital, Luton, UK.
BMJ Case Rep. 2018 Jan 18;2018:bcr-2017-222092. doi: 10.1136/bcr-2017-222092.
Allergic reactions to metals following joint arthroplasty represent a rare and poorly understood phenomenon. Much is still unknown regarding the natural history of this complication, and how it can best be prevented and managed. We present a case of a 68-year-old woman who underwent a left total knee arthroplasty for treatment of osteoarthritis. After an initial uneventful postoperative course, she developed a troublesome erythematous rash both around the incision site and over her trunk. Blood testing revealed no evidence of infection and clinically her prosthesis was functioning well. Skin patch testing revealed positive results for vanadium (+) and palladium (+). Her cutaneous symptoms are currently being managed conservatively and have shown a partial response to topical steroids. Revision surgery remains a long-term treatment option should conservative therapy fail; however, it would require a custom-made prosthesis as no standard tibial component is free from vanadium.
关节置换术后对金属的过敏反应是一种罕见且了解甚少的现象。关于这种并发症的自然病程以及如何最好地预防和处理，仍有许多未知之处。我们报告一例68岁女性，因骨关节炎接受了左全膝关节置换术。术后初期过程平稳，但她在切口部位周围及躯干出现了令人烦恼的红斑皮疹。血液检测未发现感染迹象，临床上她的假体功能良好。皮肤斑贴试验显示钒（+）和钯（+）呈阳性结果。她的皮肤症状目前正在接受保守治疗，局部使用类固醇已显示出部分疗效。如果保守治疗失败，翻修手术仍是一种长期治疗选择；然而，这需要定制假体，因为没有不含钒的标准胫骨组件。
