Table 2.
Surgical Findings and Outcomes of Revision Surgery for Reported Metal Hypersensitivity Cases After Total Knee Arthroplasty
| Study | Index TKA: Alloy (Manufacturer) | Time in Situ (mo) | Histopathology Findings | Revision TKA: Alloy (Manufacturer) | Follow-up (mo) | Clinical Results |
|---|---|---|---|---|---|---|
| Anand et al12 | Co-Cr (Zimmer) | 20 | Lymphoplasmacellular fibrinous tissue, consistent with a type IV allergic reaction | Ti (Biomet) | 14 | Improved motion, resolved pain |
| Thomsen et al16 | Co-Cr (Aesculap) | Approximately 48 | Not reported | Zr-and N-coated Co-Cr (Aesculap) | 18 | Improved motion, resolved pain, resolution of eczema |
| Bergschmidt et al13 | Co-Cr, Ti (Lima) | 3 | Lymphoplasmacellular fibrinous tissue, consistent with type IV allergic reaction | Ceramic femur, Ti tibia (CeramTec, Lima) | 12 | Improved motion, no pain at rest |
| McMaster and Patel14 | Co-Cr (DePuy) | 20 | Eosinophilic fibrinous tissue devoid of cells and corrosive metallic product consistent with ALTRa | Co-Cr (DePuy) | 8 | Resolved pain, wound healing with coverage |
| Thakur et al15 | Co-Cr (Stryker) | 3 | Synovial hypertrophy and hyperplasia with perivascular lymphoplasmacytic aggregates and myxomatous degeneration | Oxinium femur, Ti tibia (Smith & Nephew) | 12 | Improved motion, resolved pain |
| Co-Cr (Stryker) | 24 | Chronic histiocytic reaction to birefringent small-particular material | Oxinium femur, Ti tibia (Smith & Nephew) | 24 | Improved pain | |
| Co-Cr (Stryker) | 24/28 | Synovial hypertrophy and hyperplasia associated with diffuse mononuclear and giant cell reaction, perivascular chronic inflammation | Oxinium femur (Smith & Nephew) | 12 | Preserved motion, resolved pain | |
| Co-Cr (Stryker) | 5 | Synovial hyperplasia with chronic histiocytic response | Oxinium femur, Ti tibia (Smith & Nephew) | 12 | Preserved motion, resolved pain | |
| Co-Cr (Stryker) | 24 | Foreign body reaction to colorless refractile material with synovial cell hyperplasia and foci of myxoid degeneration | Oxinium femur (Smith & Nephew) | 4 | Improved motion, resolved pain |
a
Case report describing adverse metal reaction related to taper corrosion in revision rotating hinge prosthesis.
ALTR = adverse local tissue reaction, Co = cobalt, Cr = chromium, N = nitrogen, Ti = titanium, TKA = total knee arthroplasty, Zr = zirconium