Division of Environmental & Occupational Health Sciences, National Jewish Health, 1400 Jackson St., Denver, CO, 80206, USA.
Environmental & Occupational Health, University of Colorado School of Public Health Anschutz Medical Campus, 13001 E 17th Pl, Aurora, CO, 80045, USA.
Clin Rev Allergy Immunol. 2019 Feb;56(1):72-85. doi: 10.1007/s12016-018-8707-y.
Surgical implants are essential elements of repair procedures to correct worn out joints, damaged spinal components, heart and vascular disease, and chronic pain. However, many of the materials that provide stability, flexibility, and durability to the implants are also immunogenic. Fortunately, allergic responses to surgical implants are infrequent. When they do occur, however, the associated pain, swelling, inflammation, and decreased range of motion can significantly impair the implant function. Given the high numbers of joint replacements performed in the developed world, allergic reactions to orthopedic implants form the largest category of allergic responses. The most important allergens in this category include nickel, cobalt, chromium, and bone cement. These allergens are also the most important in reactions to spinal surgeries. Multiple cardiac and neurostimulatory devices are constructed of metals and adhesives that can be sensitizing in some individuals. Implantable pulse generators, important in cardiac pacemakers, gastric stimulators, and neurostimulators, may include components made of stainless steel, titanium alloy, platinum and iridium, epoxy resins, poly methyl methacrylates, and isocyanates, all of which are immunogenic in some patients. Cardiac stents and patches are often made of Nitinol, a composite of nickel and titanium. More surgical procedures are closed using skin glues, which are also capable of triggering a blistering contact dermatitis. Patch testing is the gold standard to determine sensitization, and this review provides a list of standard allergens to test for different implants. The patients most appropriate for testing include (1) pre-operative joint replacement patients with a prior history of skin reactions to metal jewelry, jean snaps, watch bands, metal glass frames, artificial nails, or skin glue; (2) post-operative joint replacement failure patients needing revision without an obvious cause such as infection or mechanical incompatibility; and (3) post-operative cardiac or neurological patients with localized rash, pain, swelling, or inflammation near or over the implant.
外科植入物是修复磨损关节、受损脊柱部件、心脏和血管疾病以及慢性疼痛的重要元素。然而，许多提供稳定性、灵活性和耐用性的植入物材料也具有免疫原性。幸运的是，对手术植入物的过敏反应并不常见。但是，当它们发生时，相关的疼痛、肿胀、炎症和运动范围减小会显著损害植入物的功能。鉴于在发达国家进行的关节置换数量众多，对骨科植入物的过敏反应构成了过敏反应的最大类别。在这一类中最重要的过敏原包括镍、钴、铬和骨水泥。这些过敏原也是脊柱手术中最重要的过敏原。多种心脏和神经刺激装置由金属和粘合剂构成，这些在某些个体中可能具有致敏性。可植入脉冲发生器在心脏起搏器、胃刺激器和神经刺激器中很重要，可能包含由不锈钢、钛合金、铂和铱、环氧树脂、聚甲基丙烯酸甲酯和异氰酸酯制成的组件，所有这些在某些患者中都是免疫原性的。心脏支架和补丁通常由镍钛诺制成，这是镍和钛的复合材料。更多的手术程序使用皮肤胶封闭，这也可能引发水疱性接触性皮炎。斑贴试验是确定致敏的金标准，本综述提供了不同植入物测试的标准过敏原列表。最适合进行测试的患者包括：（1）术前关节置换患者，有金属首饰、牛仔裤扣、表带、金属眼镜框、人造指甲或皮肤胶皮肤反应史；（2）术后关节置换失败患者，需要进行无明显原因（如感染或机械不兼容）的翻修；（3）术后心脏或神经系统疾病患者，在植入物附近或上方出现局部皮疹、疼痛、肿胀或炎症。
