Thomas P, Summer B
Klinik und Poliklinik für Dermatologie und Allergologie, Ludwig-Maximilians-Universität, Munich, Germany.
Allergol Select. 2017 Aug 4;1(1):59-64. doi: 10.5414/ALX01394E. eCollection 2017.
Osteosynthesis materials or artificial joint replacement make part of clinical routine. In case of complaints mostly mechanical causes or infections are found. Metals like nickel, chromium and cobalt or bone cement components like acrylates and gentamicine may however potentially cause intolerance reactions to implants. Correspondingly, eczema, delayed wound/bone healing, recurrent effusion, pain or implant loosening have been described as manifestation of implant allergy. In contrast to the high incidence of cutaneous metal allergy, allergies associated with implants are rare. Diagnosis of metal implant allergy is based on excluding differential diagnoses - in particular infection - and on a combined approach of allergological diagnostics by patch test and histopathology of periimplant tissue. Risk factors for allergic sensitization to implants or triggering periimplant allergic reactions in the case of preexisting cutaneous metal allergy are unknown. Despite the risk of developing complications being unclear, titanium-based osteosynthesis materials are recommended for metal-allergic patients and the use of metal-metal couplings in arthroplasty is rather not recommended for such patients. If a regular, potentially applicable CoCr-polyethylene articulation is preferred, the patient has to be well informed and has to give his written consent.
骨合成材料或人工关节置换是临床常规操作的一部分。出现问题时，大多发现是机械原因或感染。然而，镍、铬和钴等金属或丙烯酸酯和庆大霉素等骨水泥成分可能会对植入物产生潜在的不耐受反应。相应地，湿疹、伤口/骨愈合延迟、反复积液、疼痛或植入物松动被描述为植入物过敏的表现。与皮肤金属过敏的高发病率相比，与植入物相关的过敏很少见。金属植入物过敏的诊断基于排除鉴别诊断——尤其是感染——以及通过斑贴试验和植入物周围组织的组织病理学进行的变应性诊断的综合方法。对植入物过敏致敏或在已有皮肤金属过敏的情况下引发植入物周围过敏反应的危险因素尚不清楚。尽管发生并发症的风险尚不清楚，但对于金属过敏患者，推荐使用钛基骨合成材料，而对于此类患者，在关节成形术中不建议使用金属-金属耦合。如果首选常规的、可能适用的钴铬聚乙烯关节，必须充分告知患者并获得其书面同意。
