Knee Replacement Allergies – Nothing to Sneeze At?

Knee Replacement Allergies – Nothing to Sneeze At?

Each year, hundreds of thousands of knee replacements are performed. In knee replacement, the worn ends of the bones that make up the knee joint are replaced with metal and plastic implants. In most cases, results are excellent, however in rare cases, an immune response may arise and can become problematic. That is, the patient may suffer from an allergy or hypersensitivity to the metallic components of the implant. Symptoms may include warmth or swelling at the knee, a skin rash and even loosening of the implant.1

This phenomenon is so rare, that its very existence has been debated. But at this year’s annual meeting of the American Academy of Orthopaedic Surgeons, a paper was presented documenting what appear to be allergic reactions to knee replacements.2 Dr. Alvin Ong et. al. recorded 19 cases from 2005-2008 where total knee replacement failures were attributed to metal sensitivity. The authors ruled out all other possible causes of implant failure and then performed a special test, the lymphocyte transformation test (LTT) which looks at a patients sensitivity to certain metals. Seventeen of the nineteen patients with failed knee replacements were tested. Ten patients recorded high sensitivity while the remaining seven indicated mild sensitivity.

Following the sensitivity testing, 16 of the patients had a second procedure where the traditional metal was removed and replaced with a non-metallic implant (the ceramic Oxinium implant from manufacturer Smith and Nephew). Following this knee replacement, the authors reported good results and elimination of the inflammation that was present with the traditional metal implant.

So although an allergic reaction to metal knee replacement implants may be rare, it is not unheard of. Unfortunately, diagnostic tests like LTT are relatively expensive and persons testing positive are not always symptomatic.1 In their article, Dr. Ong et. al. suggest that surgeons be mindful of the possibility of metal hypersensitivity especially when failures of implants are noted and cannot be attributed to other factors.

1 Rabin SI, Graf CN, Hopkinson, WJ, Hallab NJ “Immune Response to Implants.” emedicine.medscape.com. 08 Mar. 2009. <http://emedicine.medscape.com/article/1230696-overview>

2 Jafari SM, Della Valle CJ, Orozco F, Ong AC. “Metal Hypersensitivity Following Total Knee Arthroplasty: A Real Phenomenon?” 2009 AAOS Annual Meeting, Poster No. P134

Comments

4 Responses to “Knee Replacement Allergies – Nothing to Sneeze At?”

  1. segue17 on August 28th, 2009 2:41 pm

    Has anyone heard of a hypersensitivity or allergy to the ceramic Oxinium implant from manufacturer Smith and Nephew? I had TK in June of 2008 and following complications a revision with another (ceramic Oxinium implant from manufacturer Smith and Nephew) in March of 2009. [At the time of the revision the scar tissue/inflammation surrounding the joint was the depth equivalent to the length of my surgeons thumb...pic's if you're interested...] I am experiencing increasing fluid build up in the knee which is being aspirated to relieve the intense pressure every 4 weeks (roughly 50cc’s each time) and am now going through testing for every type of possible infection or allergy there is. I do have the ability to straighten my knee and despite the extra fluid can get about 115 degrees of flexion. I just can’t seeem to find any info about this anywhere. At 48 I am fairly young for a TK which was due to a series of injuries.

  2. Bill McCullough on October 28th, 2009 3:55 pm

    Morning,
    I was looking for something related to a rash in conjunction with a TKR. In 2002 I had the procedure.
    I had nine surgeries on my knee with the tenth being the replacement.
    I had everything from the carticel implant to the tibal tuberosity sic. to four or five simple scopes.
    Knee still doesn’t work but I’ll live with it. I have about 65 degrees when bending where I have 110 in the right leg.
    Anyway, shortly after the replacement I noticed a rash below the knee that I cannot get rid of. Several doctors have prescribed meds for what they think it might be but nothing works. When I asked my surgeon about it he commented he had seen that in several other cases but had no idea what it was.
    Just wondering if anyone else has had this.

  3. Paul York on January 28th, 2010 2:03 pm

    Hi all,

    I had a TK last June, I have been experiencing a rash on the outside of the knee as well as swelling and heat since then. About a week ago I started getting a rash all over my body. My surgeon is very confused as to what is happening, so has recommended I get a second opinion. I came across this website yesterday, and feel pretty sure this is what is happening to my knee.

  4. Bobbie Crowley on May 20th, 2010 9:58 pm

    My dentist removed all metal fillings because he believed the amalgum fillings could be a cause of unusuall health problems. As person with chemical allergies, is total knee replacement worth the risk?

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