Bogdanova-Bennett Anna, Sagi Amit, Asopa Vipin, Field Richard E, Sochart David H
Academic Surgical Unit, South West London Elective Orthopaedic Centre, Epsom, UK.
EFORT Open Rev. 2021 Oct 19;6(10):825-838. doi: 10.1302/2058-5241.6.210051. eCollection 2021 Oct.
Approximately 60,000 cemented femoral stems are implanted in the UK each year with the majority being manufactured from stainless steel containing 10-15% nickel. Nickel hypersensitivity has been reported in up to 13% of the general population and there is a concern that nickel hypersensitivity might adversely affect the outcome of total hip replacement (THR). We reviewed the current literature on the potential link between nickel hypersensitivity and THR complications, and the usefulness of patch testing.We conducted a literature search in PubMed, MEDLINE and EMBASE databases. The level of evidence and the quality of the selected studies were assessed using the Oxford Centre for Evidence-Based Medicine Criteria and the Methodological Index for Non-Randomised Studies tool, respectively.Twenty-six studies met the inclusion criteria, reporting on 1852 patients who underwent primary or revision THR. All studies detailed skin patch testing and recorded prevalence of nickel hypersensitivity from 1.5% to 33.3%. Five studies reported a rise in Nickel hypersensitivity following THR, while four reported a decreased prevalence post-operatively. Eight studies concluded that metal hypersensitivity could have developed following THR, while seven studies did not support a link between metal hypersensitivity and THR complications. Four of the studies recommended routine patch testing pre-operatively, but three others concluded that routine patch testing was not indicated.We have not identified a link between nickel hypersensitivity and THR complications, and the role of patch testing remains unclear. Further large-scale studies would be required to investigate this relationship and to clarify the role of patch testing in facilitating implant selection. Cite this article: 2021;6:825-838. DOI: 10.1302/2058-5241.6.210051.
在英国，每年大约有60000个骨水泥型股骨柄被植入，其中大多数由含10 - 15%镍的不锈钢制成。据报道，普通人群中高达13%的人对镍过敏，人们担心镍过敏可能会对全髋关节置换术（THR）的结果产生不利影响。我们回顾了关于镍过敏与THR并发症之间潜在联系以及斑贴试验有效性的现有文献。我们在PubMed、MEDLINE和EMBASE数据库中进行了文献检索。分别使用牛津循证医学中心标准和非随机研究方法学指数工具评估所选研究的证据水平和质量。26项研究符合纳入标准，报告了1852例接受初次或翻修THR的患者。所有研究都详细描述了皮肤斑贴试验，并记录了镍过敏的患病率，范围从1.5%到33.3%。五项研究报告了THR后镍过敏率上升，而四项研究报告术后患病率下降。八项研究得出结论，THR后可能会发生金属过敏，而七项研究不支持金属过敏与THR并发症之间存在联系。四项研究建议术前进行常规斑贴试验，但另外三项研究得出结论认为不需要进行常规斑贴试验。我们尚未发现镍过敏与THR并发症之间存在联系，斑贴试验的作用仍不明确。需要进一步的大规模研究来调查这种关系，并阐明斑贴试验在辅助植入物选择中的作用。引用本文：2021；6：825 - 838。DOI：10.1302/2058 - 5241.6.210051。
