Should patients be tested for metal allergies before joint replacement surgeries?

Should patients be tested for metal allergies before joint replacement surgeries?

07/21/2015

The question of whether patients should be tested for metal allergies prior to joint replacement surgeries, is a topical issue amongst orthopaedic specialists. Concerns have arisen about the role metal sensitivity may play in the development of complications following orthopaedic joint replacement surgeries. Hypersensitivity to such metals as nickel, cobalt and chromium may be responsible for pseudo-tumour formation, screw loosening and implant failure.

All metals in contact with biological systems undergo corrosion and release metal ions which can activate the immune system of susceptible individuals. This is significant as metal-on-metal prostheses are increasingly being used within orthopaedic surgeries, and hypersensitivity to metal is far from uncommon. In fact, dermal contact with metals and ingestion of metals is estimated to cause immune reactions in up to 10-15% of the population.

Unfortunately, at present, there are no tests available which can definitively predict whether an individual will or will not develop a hypersensitivity reaction upon insertion of a metallic implant. The pragmatic approach adopted by many orthopaedic surgeons is to recommend prostheses made of titanium-based alloys to patients who are known to be allergic to nickel, cobalt or chromium.

Contact patch testing is increasingly being recognised by orthopaedic surgeons as a useful preoperative method for identifying patients who may be at higher risk for experiencing a metal hypersensitivity reaction and complications following joint replacement surgeries.

At the Australian Allergy Centre, we are excited to offer contact patch testing for patients undergoing orthopaedic surgery, who have suspected metal allergy. The patch test surveys for 80% of the most common causative agents of contact allergy, including such metals as nickel, cobalt and potassium dichromate (chromium). The cost of the patch test is $220, with a medical rebate of $68.30. All consultations with our doctors are bulk-billed, and no referral is necessary.

Adala, R. et al. 2011 Orthopaedic Surgery in a Patient with Metal Sensitivity. Journal of Cutaneous and Aesthetic Surgery 4, 1, 67-68.

Cousen, P. and Gawkrodger, D. 2011 Metal allergy and second-generation metal-on-metal arthoplasties. Contact Dermatitis 66, 2, 55-62.
 

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