Table 1.
Demographics and Workup of Reported Metal Hypersensitivity Cases After Total Knee Arthroplasty
| Study | Cases (Knees ) | Gende r | Age (yr) | Index TKA: Alloy (Manufacturer) | Time in Situ (mo) | Infection Workup | Cutaneous Findings | Metal Hypersensitivity Test, Outcome (Element) |
|---|---|---|---|---|---|---|---|---|
| Anand et al12 | 1 (1)a | M | 70 | Co-Cr (Zimmer) | 20 | Normal ESR, CRP level, IL-1, negative culture and PCR | None | Patch test, positive (Ni, Co) |
| Thomsen et al16 | 1 (1) | F | 60 | Co-Cr (Aesculap) | Approxi mately 48 | Normal CRP level, negative culture | Eczematous reaction | LTT, negative |
| Bergschmidt et al13 | 1 (1) | F | 58 | Co-Cr, Ti (Lima) | 3 | Normal CRP level, negative culture | None | Patch test, positive (Ni, Pd) |
| McMaster and Patel14 | 1 (1)b | M | 65 | Co-Cr (DePuy) | 20 | Elevated ESR, CRP level, serum Co, negative aspiration and culture | Rash | LTT, negative |
| Thakur et al15 | 5 (6) | F | 78 | Co-Cr (Stryker) | 3 | Normal ESR, elevated CRP level, negative culture | None | Patch test, positive (Ni) |
| M | 64 | Co-Cr (Stryker) | 24 | Normal ESR and CRP level, negative aspirate and culture | None | Patch test, positive (Co) Known Ni allergy | ||
| F | 56 | Co-Cr (Stryker) | 24/28 | Normal ESR and CRP level | None | Patch test, positive (Co, Mn) | ||
| F | 56 | Co-Cr (Stryker) | 5 | Normal ESR and CRP level, negative aspirate | None | None | ||
| F | 64 | Co-Cr (Stryker) | 24 | Normal ESR and CRP level, negative aspirate and culture | None | Patch test, negative |
a
Patient initially presented 2 months postoperatively with positive ESR, positive CRP level, and aspirate of 56,000 nucleated cells and underwent single-stage débridement with antibiotic treatment without resolution of symptoms.
b
Case report describing adverse metal reaction related to taper corrosion in revision rotating hinge prosthesis.
Co = cobalt, Cr = chromium, CRP = C-reactive protein, ESR = erythrocyte sedimentation rate, IL-1 = interleukin 1, LTT = lymphocyte transformation test, Mn = manganese, Ni = nickel, PCR = polymerase chain reaction, Pd = palladium, Ti = titanium, TKA = total knee arthroplasty,