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Metal Hypersensitivity in Total Joint Arthroplasty

Eftekhary, Nima, MD1; Shepard, Nicholas, MD1; Wiznia, Daniel, MD1; Iorio, Richard, MD1; Long, William John, MD, FRCSC1; Vigdorchik, Jonathan, MD1

doi: 10.2106/JBJS.RVW.17.00169
Review Articles

  • * Metal hypersensitivity has been reported in various case reports and cohort studies. Type-IV (delayed-type) hypersensitivity to various implant metals, most frequently nickel, has been implicated in the pathogenesis of metal hypersensitivity.
  • * Currently, there are no guidelines for addressing suspected or known metal allergy preoperatively and there is no evidence-based support for either preoperative testing or routine use of hypoallergenic implants.
  • * Multiple diagnostic modalities are available for the workup of suspected metal hypersensitivity; the 2 most common are patch testing and lymphocyte transformation testing. However, the ability of these tests to diagnose disease and predict outcomes has not yet been demonstrated.
  • * Further research is warranted to help understand the prevalence, pathology, diagnosis, treatment, and potential avoidance of metal hypersensitivity.

1Department of Orthopaedic Surgery, NYU Langone Orthopaedic Hospital, New York, NY

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Copyright © 2018 by The Journal of Bone and Joint Surgery, Incorporated
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