Peacock C J H, Fu H, Asopa V, Clement N D, Kader D, Sochart D H
South West London Elective Orthopedic Centre, Epsom, UK.
Edinburgh Orthopedics, Royal Infirmary of Edinburgh, Edinburgh, UK.
Arthroplasty. 2022 Sep 2;4(1):40. doi: 10.1186/s42836-022-00144-5.
To assess the Nickel sensitizing potential of total knee arthroplasty (TKA), explore the relationship between hypersensitivity and clinical outcomes, and evaluate the utility of skin patch testing pre- and/or postoperatively.
A literature search was performed through EMBASE, Medline and PubMed databases. Articles were screened independently by two investigators. The level of evidence of studies was assessed using the Oxford Centre for Evidence-Based Medicine Criteria and the quality evaluated using the Methodological Index for Non-randomized Studies and Cochrane risk-of-bias tools.
Twenty studies met the eligibility criteria, reporting on 1354 knee arthroplasties. Studies included patients undergoing primary or revision TKA, pre- and/or postoperatively, and used patch testing to identify Nickel hypersensitivity. Prevalence of Nickel hypersensitivity ranged from 0% to 87.5%. One study compared the prevalence of Nickel hypersensitivity in the same patient group before and after surgery and noted newly positive patch test reactions in three patients (4.2%). Three studies reported lower prevalence of Nickel hypersensitivity in postoperative patients compared to preoperative ones. Seven studies suggested that hypersensitivity might cause adverse clinical outcomes, but six did not support any relationship. Seven studies recommended preoperative patch testing in patients with history of metal allergy, and nine concluded that testing may be valuable postoperatively.
Patients undergoing TKA with no prior history of metal hypersensitivity do not seem to be at an increased risk of developing Nickel hypersensitivity, and there is conflicting evidence that patients with pre-existing hypersensitivity are more likely to experience adverse outcomes. Patch testing remains the most commonly used method for diagnosing hypersensitivity, and evidence suggests preoperative testing in patients with history of metal allergy to aid prosthesis selection, and postoperatively in patients with suspected hypersensitivity once common causes of implant failure have been excluded, since revision with hypoallergenic implants may alleviate symptoms.
评估全膝关节置换术（TKA）的镍致敏潜力，探讨超敏反应与临床结局之间的关系，并评估术前和/或术后皮肤斑贴试验的效用。
通过EMBASE、Medline和PubMed数据库进行文献检索。由两名研究人员独立筛选文章。使用牛津循证医学中心标准评估研究的证据水平，并使用非随机研究的方法学指数和Cochrane偏倚风险工具评估质量。
20项研究符合纳入标准，报告了1354例膝关节置换术。研究纳入了接受初次或翻修TKA的患者，在术前和/或术后进行，并使用斑贴试验来识别镍超敏反应。镍超敏反应的患病率从0%到87.5%不等。一项研究比较了同一患者组手术前后镍超敏反应的患病率，发现3例患者（4.2%）斑贴试验新出现阳性反应。三项研究报告术后患者镍超敏反应的患病率低于术前。七项研究表明超敏反应可能导致不良临床结局，但六项研究不支持任何关联。七项研究建议对有金属过敏史的患者进行术前斑贴试验，九项研究得出结论，术后试验可能有价值。
既往无金属超敏反应史的TKA患者似乎发生镍超敏反应的风险并未增加，且存在相互矛盾的证据表明，已有超敏反应的患者更有可能出现不良结局。斑贴试验仍然是诊断超敏反应最常用的方法，有证据表明，对有金属过敏史的患者进行术前试验有助于假体选择，对疑似超敏反应的患者在排除植入物失败的常见原因后进行术后试验，因为使用低敏性植入物进行翻修可能会缓解症状。
