Team Approach: Metal Hypersensitivity in Total Joint Arthroplasty

Abstract

Update 

This article was updated on February 10, 2023, because of a previous error. On page 1, the title that had read “Team Approach” with the subtitle “Metal Hypersensitivity in Total Joint Arthroplasty” now reads “Team Approach: Metal Hypersensitivity in Total Joint Arthroplasty” with no subtitle.

An erratum has been published: JBJS Rev. 2023;11(2):e22.00157ER.

• » As total joint arthroplasty volume continues to grow nationwide, more uncommon complications such as metal implant hypersensitivity are reported with greater frequency in the literature.
• » Metal hypersensitivity is a challenging diagnosis given the potentially vague symptomology. It should be considered a diagnosis of exclusion, necessitating careful consideration of other potential etiologies of a failing implant before arriving at the final diagnosis of metal hypersensitivity.
• » Patients can experience substantial morbidity from implant rejection and in severe, refractory cases may even require revision arthroplasty and conversion to a hypoallergenic implant.
• » Given the complex nature of the condition, successful treatment of metal hypersensitivity to orthopaedic implants is best achieved through the use of a multidisciplinary, team-based approach. Immunologists, radiologists, and infectious disease physicians as well as orthopaedic surgeons and mechanical engineers are all vital in appropriate diagnosis and treatment of the condition.