2022 Jun 21;14(6):e26167. To comment please, Comments on Medscape are moderated and should be professional in tone and on topic. However, in some patients, hardware can become prominent or irritate a nearby . We thank Dr. Guirguis, Department of Radiology, and Williamson Medical Center for their contributions in this case report. Read the article to learn more about what triggers this side effect and how you can ask help from your doctor to avoid any complications after your surgery. Signs and symptoms of metal hypersensitivity can range from mild to severe and generalized. Given the high numbers of joint replacements performed in the developed world, allergic reactions to orthopedic implants form the largest category of allergic responses. Lump in left groin associated with shooting pain, Bilateral MOM hip resurfacings (34 mo apart). But opting out of some of these cookies may affect your browsing experience. Discussion: The MELISA test has been known to be a more sensitive test to metal allergy but lacks specificity in the proliferation of lymphocytes [3]. Absence of other contact allergens or systemic cause, 4. We use cookies on our website to give you the most relevant experience by remembering your preferences and repeat visits. For more information about spinal hardware, take a look at some of our previous blogs: Centennial Lakes Medical Center Some implants are made of non-metal materials, such as ceramics, but there's limited data about their effectiveness and longevity. 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Background Metal hypersensitivity, mostly documented in prosthesis implantation, is a rare complication after arthroplasty. The patient initially presented to the clinic with an intermittent right upper quadrant (RUQ) pain in 2016. This case highlights the variable presentation of titanium allergy that clinicians should be vigilant for. 3, no. sharing sensitive information, make sure youre on a federal Dermatol Ther (Heidelb). In the past, it was believed that people who experienced an allergic reaction to substances containing iodine were allergic to the nutrient. The patient had delayed hypersensitivity reaction to nickel in the past with erythematous rash formation and severe itching. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Fe = iron; Co = cobalt; Cr = chromium; N/A = not applicable; Ni = nickel. But sometimes a child can have what's known as anaphylaxis . The .gov means its official. The immune response associated with sensitization occurs from prolonged exposure. 18 A case of allergic reaction to surgical metal clips inserted for postoperative . Cutaneous and systemic hypersensitivity reactions to metallic implants. 2022 Oct 24;14(10):e30625. Erythema, swelling, sterile effusions, pain with limitation of movement. Symptoms of metal allergy and sensitivity. 5, no. 66/92 had symptoms (pain, reduced motion, swelling). [6] This review aims to update the reader on the general aspects of this complex topic and to briefly discuss future challenges. 145162, 2008. There are many things that could be causing the healing. It is based on symptoms that are associated with allergies in the form of rashes, urticarial, pruritus, swelling in the region of the orofacial, erythema of facial as well as oral, eczematous lesions in the area of the cheeks. Discussion Based on the level and proportion of immune cells in the sampleincluding leukocytes, eosinophils, and basophilsthe healthcare provider can diagnose DHT with a relatively high degree of confidence. 2001 Apr 14;357(9263):1205-6; author reply 1206-7 Surgical Staples Removal: Heres What You Should Know, FDA Finalizes Reclassification of Surgical Staplers from Class I to Class II. Symptoms of a Reaction Unfortunately, the symptoms of metal implant sensitivity and allergy are not well defined. Why Do Doctors Use Staples Instead of Stitches? Pseudotumors posterior to joints (4 mo apart), Pain (15/17); lump (6/17); nerve irritation or palsy (5/17); dislocation (2/17); instability (2/17); rash (1/17); none (2/17). Rare Systemic Response to Titanium Spinal Fusion Implant: Case Report These cookies do not store any personal information. A rash after surgery may be due to contact with irritants or an allergic reaction to a medication. None had issues despite confirmed allergy to one of the metals in their device (6-year follow-up). MeSH CT scan showed cystic collection of fluid with negative leukocyte scintigraphy. Orthopade. The most important allergens in this category include nickel, cobalt, chromium, and bone cement. does it exst? We discuss the presentation, investigations, and treatment of this unusual case. T. Okamura, M. Morimoto, D. Fukushima, and G. Yamane, A skin patch test for the diagnosis of titanium allergy, Journal of Dental Research, vol. One frequently encountered metal sensitivity is to nickel. Please enter a Recipient Address and/or check the Send me a copy checkbox. The skin patch test has not yet been developed as the valid standardized test for titanium allergy. Staged revision resulted in pain relief, but nerve palsy did not recover. It should NOT be regarded as diagnostic, treatment or any other type of specific medical advice to anyone. "it appears that most patients who are metal-sensitive can safely receive an orthopedic implant containing that metal without the risk of cutaneous or systemic complications. government site. Blog One of the rare complications from the use of staples in surgery is an allergic reaction, mainly because of the components or materials present in the staple. Allergic reactions occur when a substance triggers an immune response. The use of sutures are said to be beneficial in laparoscopic or robotic assisted cholecystectomies. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. Highest odds ratio for restenosis (5.41) were in nickel positives. 2010 Mar;61(3):255-62; quiz 263-4. doi: 10.1007/s00105-009-1907-x. G. Forte, F. Petrucci, and B. Bocca, Metal allergens of growing significance: epidemiology, immunotoxicology, strategies for testing and prevention, Inflammation & Allergy Drug Targets, vol. Cobalt and chromium may be found not only in the appliance but also in bone cements used to set the prosthetic. According to the U.S. Food and Drug Administration, some of the most common surgical staple and stapler malfunctions reported to the regulating agency include a malformed staple, failure of the stapler in firing the staple, misfiring, application of the staples to wrong tissue, and a surgeon applying the wrong size of staples to a tissue. These symptoms can make your child feel bad, but it's not life-threatening. The site is secure. This corrosion causes the formation of metal ions that ultimately trigger the inflammatory immune response. ", < 1% develop cutaneous reactions versus 2025% of patients who develop implant-induced metal sensitivity without any allergic skin manifestations. Itchy eyes, nose or roof of mouth. Allergy symptoms, which depend on the substance involved, can affect your airways, sinuses and nasal passages, skin, and digestive system. Commenting is limited to medical professionals. Revision to cementless total hip with ceramic-onceramic bearing led to symptom resolution. The diagnosis of DHT can be difficult, in part because a hypersensitive reaction on the skin doesn't always cause a hypersensitive reaction on internal tissues, or vice versa. Many types of metallic implants can cause cutaneous allergic reactions, from orthopedic and dental implants to cardiac stents and pacemakers. Our case is about a 28-year-old female presenting with a spectrum of abdominal symptoms with a complicated medical history. She was diagnosed with pneumonia twice followed by two sinusitis episodes from January 2020 to March 2020. The authors declare that they have no competing interests. On the other hand, another rare case of a female patient was also the topic of one case report. eCollection 2022. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. doi:10.1007/s11420-016-9514-8. Can the human body reject surgical screws used to repair swelling. Front Bioeng Biotechnol. He exhibited allergic symptoms (eczema) after orthopedic surgery. Click the topic below to receive emails when new articles are available. The base metals are found in the highest quantities, but smaller amounts of other metals, such as nickel and aluminum, are often used. The risk of surgical revision was not increased in patients with metal allergies, and the risk of metal allergy was not increased in patients who were operated on, in comparison with controls. CT scan was promptly ordered to rule out the severe complication of toxic megacolon as a result of C. difficile infection. It can be challenging to diagnose and discover RFB due to the different manifestations of each case and nonspecific symptoms. Rushing GD, Goretsky MJ, Gustin T, Morales M, Kelly RE Jr, Nuss D. J Pediatr Surg. Symptoms of an allergy or sensitivity to metal in a knee replacement include: Symptoms of a metal allergic reaction do not typically appear for months or years after a knee replacement. Allergic reactions to staples, clips, and other metallic implants may be rare, but it can have adverse health effects on a patient. 2022 Dec 19;24:153-170. doi: 10.1016/j.bioactmat.2022.12.012. If you think you may have a medical emergency or a major medical problem, call your doctor or 911 immediately. 8600 Rockville Pike Reactions to metals in knee replacements happen when the immune system overreacts or launches a defensive assault on the artificial joint and surrounding tissues, triggering local inflammation. Patients can present with atopic dermatitis, pruritus, edema, urticaria, impaired healing fractures, pain, and necrosis of implants [ 3 ]. This will improve the patients quality of life and prevent serious complications. Its symptomsitching, knee pain, skin rashes, joint stiffness, and swellingcan also have other causes, which makes this difficult to diagnose. Prospective: 171 total stents; in-stent restenosis in 100% of patients with positive patch-test result but in only 57% of patients with negative patchtest results; no control group; only significant differences were for nickel and molybdenum. The https:// ensures that you are connecting to the 2011;22(2):65-79. The first case of a dermatitis reaction over a stainless steel fracture plate was described in 1966. People with suspected metal allergies or sensitivities should undergo testing prior to knee replacement surgery. Nickel allergy to orthopaedic implants: A review and case series Contact Allergy to metals such as nickel, cobalt, and chromium is prevalent in the general population. Patients who have pain around metal implants that is also associated skin changes (eczema) should be evaluated for possible metal sensitivity. Individuals should always consult a licensed and qualified health care provider for evaluation, diagnosis and treatment recommendations regarding their specific spine or other medical problems. J Allergy Clin Immunol Pract. Please confirm that you would like to log out of Medscape. Iodine is essential for thyroid function, and an allergy to it would be life . 4, pp. The patients preop white blood cell (WBC) count was 5.2K/L, absolute neutrophil count was 3281 cells/L, and absolute lymphocyte count was 1284 cells/L. official website and that any information you provide is encrypted This can cause mild to significant local discomfort. PMC Hypersensitivity or allergy can occur after contact with various metals. Dull aching pain, swelling, followed by supracondylar fracture. > 1 stenosis = 60 (case) 1 stenosis = 68 (control), Bare metal stainless steel 316L stents; 19% (24/128) of all patients were nickel positive; "24 nickel positives, 30% in study group, 9% in control group (, Multivariate analysis: most significant predictor of chronic in-stent restenosis: reference vessel diameter (. Would you like email updates of new search results? reports an 86-year-old woman who presented three years to postlaparoscopic cholecystectomy with subdiaphragmatic abscess due to titanium surgical clips used during the procedure [4]. Prosthetic joints containing metals nickel, chromium, and cobalt are most likely to cause a reaction. 2015 Sep-Oct;3(5):683-95. doi: 10.1016/j.jaip.2015.07.011. official website and that any information you provide is encrypted During the cholecystectomy, six titanium surgical clips were placed in the RUQ. People with known metal allergies or sensitivities should tell their surgeon prior to knee replacement surgery. It also sheds light on retained foreign bodies as a possible cause of abdominal pain in patients who have gone through various surgical procedures in the past. and transmitted securely. W. S. Towers and K. Kurtom, Rare systemic response to titanium spinal fusion implant: case report, Cureus, vol. Titanium is a known metal used widely in the medical field and can cause allergic reactions with complications. 1 Patients with MHS reactions to implants typically have prolonged eczematous dermatitis.8 Although the majority of MHS reactions are localized, more widespread inflammation has been reported. World J Orthop. Many people have known skin sensitivities to various metals. Kohal RJ, Burkhardt F, Chevalier J, Patzelt SBM, Butz F. J Funct Biomater. Revision to a ceramic-on-ceramic THR led to symptom resolution. led to symptom resolution; awaiting revision on other side. Front Immunol. Delayed Titanium Hypersensitivity and Retained Foreign Body - Hindawi Further Reading After removal of dental implants, the eczema disappeared completely. Patch-tested at time of stenting and again in 6 mo; 6.9% were nickel allergic, but 37% developed instent restenosis; 1/3 nickel-allergic patients developed diffuse in-stent restenosis. Type I hypersensitivity reaction may manifest as anaphylaxis causing urticarial plaques or papules on the skin [3]. You must declare any conflicts of interest related to your comments and responses. Exploring allergic reactions to medical implants | VailDaily.com Moreover, metal allergy screening should be considered for patients with past hypersensitivity reactions before any surgery. However, around 10% to 15% are not satisfied for various reasons, including persistent pain and the loss of joint flexibility. Revision to conventional THR led to resolution of pain. FOIA The case also unfolds rare differential diagnoses to keep in mind when encountering a patient with abdominal pain and associated nonspecific symptoms. Metal Hypersensitivity After Spinal Instrumentation: When to Suspect She also reported low-grade fever, nausea, vomiting, joint pain, bloody diarrhea, and inability to keep her food down. The abdominal pain is associated with titanium allergy reaction from previously inserted titanium-based surgical clips. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Your Injury:Bladder SlingGadolinium (MRI)Hernia MeshIVC filterNuVasive MAGECParagardStryker HipSurgical StaplerTransvaginal Mesh------AbilifyActosAduhelmBelviqCymbaltaEffexorElmironEssureGranufloDepakoteGeodonInvegaInvokanaLyricaNexiumOpioidsParaquatRisperdalRoundupTestosterone therapyTalcum PowderTaxotereXareltoZantacZofranZoloftZinbryta, State:AL AlabamaAK AlaskaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareFL FloridaGA GeorgiaHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaOH OhioOK OklahomaOR OregonPA PennsylvaniaRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY WyomingOther. The Improvement of Nonspecific Chronic Symptoms Post-Gallbladder Clip Removal. 2022 Nov 28;13:1050315. doi: 10.3389/fimmu.2022.1050315. Patient satisfaction after total knee replacement: a systematic review. Metals most likely to cause a reaction, all of which may be used to make knee replacements, include: A 2021 study found a link between failed joint replacements and metal hypersensitivity. M. Goutam, C. Giriyapura, S. K. Mishra, and S. Gupta, Titanium allergy: a literature review, Indian Journal of Dermatology, vol. In our case, the pigtail catheter was found as a retained surgical body lodged in the patients cecum. 2013 Jun-Jul;79(4):38-43. The patients social history is insignificant, with no smoking or alcohol consumption. Injury to the Teeth, Blood Vessels and Nerves. The surgical pathology report for the removed catheter specified foreign body consisting of synthetic stent measuring 10.0cm in length and 0.3cm in diameter (Figure 4). 97100, 2017. FOIA Revision on one side. sharing sensitive information, make sure youre on a federal It explores the causes and symptoms of a reaction and what to do if you suspect one. Nickel is one of the most common allergens, and can cause local contact dermatitis characterized by itching and skin reddening. You will receive email when new content is published. Sneezing. This may not always be possible, and an implant made with nickel may be the most appropriate implant available for your condition. Food allergies: You may feel tingling in your mouth . Most skin reactions are eczematous and allergic in nature, although urticarial, bullous, and vasculitic eruptions may occur. Basko-Plluska JL, Thyssen JP, Schalock PC. 2000 Dec 2;356(9245):1895-7 The patients most appropriate for testing include (1) pre-operative joint replacement patients with a prior history of skin reactions to metal jewelry, jean snaps, watch bands, metal glass frames, artificial nails, or skin glue; (2) post-operative joint replacement failure patients needing revision without an obvious cause such as infection or mechanical incompatibility; and (3) post-operative cardiac or neurological patients with localized rash, pain, swelling, or inflammation near or over the implant. J Am Acad Orthop Surg. Allergy in total knee replacement surgery: Is it a real problem? 3 Titanium Implant Side Effects and How to Minimize Your Risk This article discusses knee replacement metal allergies and sensitivities. We also use third-party cookies that help us analyze and understand how you use this website. The delayed hypersensitivity occurs due to the natural corrosion of metals over time. Common symptoms of MHS reactions include localized pain, swelling, redness, warmth, loosening, draining, itching/burning, and implant instability. Middleton S, Toms A. Foot & Ankle Problems: Allergy to metal screws - HealthBoards Although inflammation is the body's natural response to anything it considers foreign and harmful, it can cause pain and other symptoms if it occurs in the absence of a genuine threat. However, titanium staples are not made of pure titanium. Total knee arthroplasty (TKA) is generally a very successful surgery, and the vast majority of people who undergo it are satisfied with the results. Within a few days, she started having vomiting, bloating, weakness, fatigue, and intense RLQ abdominal pain. 1, pp. This website also contains material copyrighted by 3rd parties. ALVAL = aseptic lymphocytic vasculitisassociated lesions; Co = cobalt; Cr = chromium; CT = computed tomography; F = female; M = male; MOM = metal-on-metal; Ref. Eleven months prior, the patient underwent cholecystectomy, or surgery to remove the gallbladder, where six titanium surgical clips were used. Instead, metal hypersensitivities typically present as contact dermatitis. So, skin testing for nickel, cobalt, and chromium hypersensitivity has limited value in diagnosing DHT. They always include a percentage of nickel, which is a known allergen. The best way to avoid postoperative issues is to routinely ask patients prior to surgery if they have any known MHS including problems with cosmetic jewelry. HHS Vulnerability Disclosure, Help Symptoms can arise as acute inflammatory response, infection, abscess, or aseptic inflammation and exudative without infection in the body cavities [13]. The most common metals used in orthopedic implants are: Solid metal implants include orthopedic plates and screws. Due to ongoing chronic symptoms, CT scan incidentally revealed a portion of a lodged pigtail catheter in the cecum. doi: 10.7759/cureus.26167. Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery. When determining if the patient is having an allergic reaction to their hardware, the first step is to investigate the materials that make up the hardware in question. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams. Having a metal allergy or sensitivity doesn't mean getting a metal implant like a surgical screw, plate, or joint replacement is entirely off limits or that the body will reject it. By postoperative day 6, the patients symptoms of abdominal distension resolved and her RLQ pain also diminished. Case Reports and SeriesSystemic Nickel Allergy after Internal Fixation of a Bunionectomy. Multiple cardiac and neurostimulatory devices are constructed of metals and adhesives that can be sensitizing in some individuals. 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Fage SW, Muris J, Jakobsen SS, Thyssen JP. Home / Surgical Stapler Lawsuit / Can You Have an Allergic Reaction to Surgical Staples? What are the symptoms of an allergic reaction to titanium? In general, orthopedic implants are alloys, meaning they contain more than one type of metal. Patients: Retained foreign bodies (RFB) are also possible complications of any surgical procedure. Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery. The Opioid Epidemic. Hay fever, also called allergic rhinitis, can cause . 62, no. Rash after surgery: Causes, other symptoms, diagnosis, and treatment But while reactions to surgical hardware and implants are rare, they do sometimes occur. 2011American Contact Dermatitis Society. The patient was referred to an infectious disease specialist and kept on a course of oral vancomycin and fidaxomicin. Large periprosthetic cystic mass removed surgically. Please enable it to take advantage of the complete set of features! By Jonathan Cluett, MD Whether a similar sensitivity may develop to metal implanted inside the bodywhere it doesn't touch the skinisn't yet well understood, but there is some evidence it can happen. Metals corrode in biologic systems, allowing for hapten formation.
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