Department of Dermatology, Allergy Unit, University Hospital, Basel, Switzerland.
Swiss Tropical and Public Health Institute, Basel, Switzerland.
Contact Dermatitis. 2018 Aug;79(2):91-98. doi: 10.1111/cod.13032. Epub 2018 Jun 11.
Hypersensitivity to metals as a cause of implant-related complications has been a subject of controversy. Projections indicate an increase in the frequency of joint replacements of between 300% and 600% by the year 2030; therefore, this issue is of considerable interest.
To evaluate sensitization to implant materials in patients with implant-related complications, to identify allergens, and to clarify whether hypersensitivity is a relevant cause.
Patients with implant-related complications or a positive history of contact allergy and planned total joint replacements referred for allergological investigation between 2004 and 2017 were retrospectively analysed.
In total, 311 patients were included. A positive patch test reaction to a metal was seen in 64.4% of preoperative patients and in 54.6% of patients with implant-related complications. Common alloy metals such as cobalt, chromium and titanium gave positive reactions in up to 2.9% of patients with implant-related complications. None of the patients with skin changes had a positive patch test reaction to an implant metal.
Other factors, such as the type of replaced joint and mechanical stress, seem to be more relevant for implant-related complications. Sensitization to metals or other materials seems to rarely play a role, and is overestimated.
金属过敏作为植入物相关并发症的一个原因一直存在争议。预测表明，到 2030 年，关节置换的频率将增加 300%至 600%；因此，这个问题引起了相当大的关注。
评估植入物相关并发症患者对植入物材料的致敏情况，确定过敏原，并阐明过敏反应是否为相关原因。
对 2004 年至 2017 年间因植入物相关并发症或有接触过敏史且计划行全关节置换术而接受过敏检查的患者进行回顾性分析。
共纳入 311 例患者。术前患者中有 64.4%和植入物相关并发症患者中有 54.6%对金属的斑贴试验反应阳性。常见的合金金属，如钴、铬和钛，在多达 2.9%的植入物相关并发症患者中出现阳性反应。没有皮肤改变的患者对植入金属有阳性斑贴试验反应。
其他因素，如置换关节的类型和机械应力，似乎与植入物相关并发症更相关。对金属或其他材料的致敏作用似乎很少起作用，且被高估了。
