Metal hypersensitivity in total joint arthroplasty

This literature review was published in Ann Allergy Asthma Immunology in 2014.

Total joint arthroplasty procedures are increasing, as are the hypersensitivity reactions to these implants. We don't know if metal joint implants increase metal sensitivity or whether metal sensitivity leads to prosthesis failure.

How to diagnose metal hypersensitivity in total joint arthroplasty ?

Patch testing is still the most widely used method for determining metal hypersensitivity. However, there are no standardized commercial panels specific for total joint replacements available at this time.

In vitro testing has shown comparable results in some studies. However. its use in the clinical setting may be limited by the cost and need for specialized laboratories.

Hypersensitivity testing is generally recommended before surgery for patients with a reported history of metal sensitivity.

In cases of metal hypersensitivity-related joint failure, surgical revision ultimately may be required.

Evaluation of hypersensitivity reactions after total joint arthroplasty requires a systematic approach, including:

- careful history
- targeted evaluation with skin patch test
- possibly in vitro studies, for nickel only as of 2019

The patch test is the standard diagnostic test for metal allergy. The MELISA blood test is not validated against the patch test, therefore not recommended as of 2019. The Nickel Lymphocyte Proliferation Test (NiLPT) (blood test via National Jewish) is validated against the patch test but is not more accurate, and it only tests for nickel. The patch test can test for multiple allergens.

Metal Implant Grouping patch test can be helpful:
https://www.smartpracticecanada.com/shop/wa/style?id=SCSERIESOINA

References:

Metal hypersensitivity in total joint arthroplasty. Pinson ML1, Coop CA2, Webb CN2. Ann Allergy Asthma Immunol. 2014 Jun 13. pii: S1081-1206(14)00337-8. doi: 10.1016/j.anai.2014.05.012. [Epub ahead of print]
http://www.ncbi.nlm.nih.gov/pubmed/24934108
https://www.arthritis.org/living-with-arthritis/treatments/joint-surgery/candidates/considerations/metal-implant-allergies.php
https://www.nationaljewish.org/about/news/press-releases/2013/new-blood-test-implant
https://www.nationaljewish.org/treatment-programs/tests-procedures/allergy/metals-allergy-testing
https://www.nationaljewish.org/NJH/media/pdf/NiLPT-Test.pdf

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