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 testing
- possibly in vitro studies


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]

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