Delimar Domagoj, Bohaček Ivan, Paštar Zrinjka, Lipozenčić Jasna
Assist. Prof. Zrinjka Paštar, MD, PhD, Department of Health Studies , University of Zadar , Splitska 1 , 23000 Zadar, Croatia;
Acta Dermatovenerol Croat. 2018 Apr;26(1):39-43.
Implant degradation products have shown signs of a cutaneous allergic response after implantation of a metal orthopedic replacement, loosening and failure of the joints as well as skin rashes, general fatigue, pain, and impaired wounds and bone healing. The prevalence of contact skin sensitivity in patients with a joint replacement device is higher than that in the general population. This delayed hypersensitivity to metallic orthopedic implants is more clearly defined and is a contributing factor to implant failure. Nickel was associated with hypersensitivity responses as the first cause in metallic orthopedic implants as early as 1966 by Foussereau and Laugieru and is a commonly used metal in alloys because it grants necessary strength and durability to the implant. Herein we report on delayed hypersensitivity to nickel sulfate in a patient with pain, fatigue, and contact allergic dermatitis in both inguinal regions, with instability of the left acetabular part and with five hip replacements from 1987 to 2013. The findings of this report support that primary sensitization to a metal due to an implant itself might develop. Proper investigation in patients with history or prior hypersensitivity reactions to metals and test evaluation before orthopedic device implantation is needed. before orthopedic device implantation is needed.
植入式骨科金属置换物植入后，其降解产物已出现皮肤过敏反应迹象，包括关节松动、失效，以及皮疹、全身乏力、疼痛、伤口愈合不良和骨愈合受损。关节置换装置患者的接触性皮肤敏感患病率高于普通人群。这种对金属骨科植入物的迟发型超敏反应定义更为明确，是植入物失效的一个促成因素。早在1966年，福塞罗和劳吉耶就指出镍是金属骨科植入物超敏反应的首要原因，镍是合金中常用的金属，因为它赋予植入物必要的强度和耐用性。在此，我们报告一例患者，该患者双侧腹股沟区疼痛、乏力并患有接触性过敏性皮炎，左髋臼部不稳定，在1987年至2013年间进行了五次髋关节置换，对硫酸镍存在迟发型超敏反应。本报告结果支持因植入物本身导致对金属产生原发性致敏可能会发生。对于有金属过敏史或既往过敏反应的患者，在骨科器械植入前需要进行适当的调查和试验评估。
