Metal Hypersensitivity and Total Knee Arthroplasty.

Journal Article (Journal Article;Review)

Metal hypersensitivity in patients with a total knee arthroplasty (TKA) is a controversial topic. The diagnosis is difficult, given the lack of robust clinical validation of the utility of cutaneous and in vitro testing. Metal hypersensitivity after TKA is quite rare and should be considered after eliminating other causes of pain and swelling, such as low-grade infection, instability, component loosening or malrotation, referred pain, and chronic regional pain syndrome. Anecdotal observations suggest that two clinical presentations of metal hypersensitivity may occur after TKA: dermatitis or a persistent painful synovitis of the knee. Patients may or may not have a history of intolerance to metal jewelry. Laboratory studies, including erythrocyte sedimentation rate, C-reactive protein level, and knee joint aspiration, are usually negative. Cutaneous and in vitro testing have been reported to be positive, but the sensitivity and specificity of such testing has not been defined. Some reports suggest that, if metal hypersensitivity is suspected and nonsurgical measures have failed, then revision to components fabricated of titanium alloy or zirconium coating can be successful in relieving symptoms. Revision should be considered as a last resort, however, and patients should be informed that no evidence-based medicine is available to guide the management of these conditions, particularly for decisions regarding revision. Given the limitations of current testing methods, the widespread screening of patients for metal allergies before TKA is not warranted.

Full Text

Duke Authors

Cited Authors

  • Lachiewicz, PF; Watters, TS; Jacobs, JJ

Published Date

  • February 2016

Published In

Volume / Issue

  • 24 / 2

Start / End Page

  • 106 - 112

PubMed ID

  • 26752739

Pubmed Central ID

  • PMC4726476

Electronic International Standard Serial Number (EISSN)

  • 1940-5480

Digital Object Identifier (DOI)

  • 10.5435/JAAOS-D-14-00290


  • eng

Conference Location

  • United States