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Revision TKR due to metal allergy

Published in N°276 - August/September 2018
Article viewed 91 times

Revision TKR due to metal allergy

By P. Mertl, Y. Bulaid, M. Dehl in category TECHNIQUE
CHU Amiens [Amiens University Hospital]

In spite of excellent clinical results and an undeniable improvement in quality of life, arthroscopic total knee replacement remains fraught with failure, and the surgical revision rate reaches around 2% after 5 years. Failures are generally due to multiple factors, although the main causes remain mechanical rather than biological.

1- Metal Allergies and TKR

In spite of excellent clinical results and an undeniable improvement in quality of life, arthroscopic total knee replacement remains fraught with failure, and the surgical revision rate reaches around 2% after 5 years (1). Failures are generally due to multiple factors, although the main causes remain mechanical rather than biological (2,3).  However, metal ions, which are mainly produced during corrosion, are released, oxidised and reabsorbed and are able to interact with the immune system and trigger effects that are toxic to it, including delayed hypersensitivity reactions (4,5). 

Nickel, cobalt and chromium are the main metal allergens (11), while vanadium, titanium and manganese are less frequently implicated (6,7).  It is difficult to diagnose an allergy to the metal in a TKR implant. Of course, the main diagnoses must be excluded, especially an infectious or mechanical cause. The main obstacle in supporting this diagnosis is the absence of universally recognised tests (8). Several in vitro tests based on immune cell reactions to metalloprotein complexes have been suggested, such as the lymphocyte transformation test (9,10); however, these do have a number of drawbacks (11), including their high cost. By contrast, in-vivo tests, such as...

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