Metal hypersensitivity testing in patients undergoing joint replacement: A systematic review

D. Granchi, E. Cenni, A. Giunti, N. Baldini

Research output: Contribution to journalArticle

72 Citations (Scopus)

Abstract

We report a systematic review and meta-analysis of the peer-reviewed literature focusing on metal sensitivity testing in patients undergoing total joint replacement (TJR). Our purpose was to assess the risk of developing metal hypersensitivity post-operatively and its relationship with outcome and to investigate the advantages of performing hypersensitivity testing. We undertook a comprehensive search of the citations quoted in PubMed and EMBASE: 22 articles (comprising 3634 patients) met the inclusion criteria. The frequency of positive tests increased after TJR, especially in patients with implant failure or a metal-on-metal coupling. The probability of developing a metal allergy was higher post-operatively (odds ratio (OR) 1.52 (95% confidence interval (CI) 1.06 to 2.31)), and the risk was further increased when failed implants were compared with stable TJRs (OR 2.76 (95% CI 1.14 to 6.70)). Hypersensitivity testing was not able to discriminate between stable and failed TJRs, as its predictive value was not statistically proven. However, it is generally thought that hypersensitivity testing should be performed in patients with a history of metal allergy and in failed TJRs, especially with metal-on-metal implants and when the cause of the loosening is doubtful.

Original languageEnglish
Pages (from-to)1126-1134
Number of pages9
JournalJournal of Bone and Joint Surgery - Series B
Volume94 B
Issue number8
DOIs
Publication statusPublished - Aug 2012

Fingerprint

Replacement Arthroplasties
Hypersensitivity
Metals
Odds Ratio
Confidence Intervals
PubMed
Meta-Analysis

ASJC Scopus subject areas

  • Surgery
  • Orthopedics and Sports Medicine

Cite this

Metal hypersensitivity testing in patients undergoing joint replacement : A systematic review. / Granchi, D.; Cenni, E.; Giunti, A.; Baldini, N.

In: Journal of Bone and Joint Surgery - Series B, Vol. 94 B, No. 8, 08.2012, p. 1126-1134.

Research output: Contribution to journalArticle

@article{087d218144924135aa71ebf56575aa35,
title = "Metal hypersensitivity testing in patients undergoing joint replacement: A systematic review",
abstract = "We report a systematic review and meta-analysis of the peer-reviewed literature focusing on metal sensitivity testing in patients undergoing total joint replacement (TJR). Our purpose was to assess the risk of developing metal hypersensitivity post-operatively and its relationship with outcome and to investigate the advantages of performing hypersensitivity testing. We undertook a comprehensive search of the citations quoted in PubMed and EMBASE: 22 articles (comprising 3634 patients) met the inclusion criteria. The frequency of positive tests increased after TJR, especially in patients with implant failure or a metal-on-metal coupling. The probability of developing a metal allergy was higher post-operatively (odds ratio (OR) 1.52 (95{\%} confidence interval (CI) 1.06 to 2.31)), and the risk was further increased when failed implants were compared with stable TJRs (OR 2.76 (95{\%} CI 1.14 to 6.70)). Hypersensitivity testing was not able to discriminate between stable and failed TJRs, as its predictive value was not statistically proven. However, it is generally thought that hypersensitivity testing should be performed in patients with a history of metal allergy and in failed TJRs, especially with metal-on-metal implants and when the cause of the loosening is doubtful.",
author = "D. Granchi and E. Cenni and A. Giunti and N. Baldini",
year = "2012",
month = "8",
doi = "10.1302/0301-620X.94B8",
language = "English",
volume = "94 B",
pages = "1126--1134",
journal = "Journal of Bone and Joint Surgery - Series B",
issn = "0301-620X",
publisher = "British Editorial Society of Bone and Joint Surgery",
number = "8",

}

TY - JOUR

T1 - Metal hypersensitivity testing in patients undergoing joint replacement

T2 - A systematic review

AU - Granchi, D.

AU - Cenni, E.

AU - Giunti, A.

AU - Baldini, N.

PY - 2012/8

Y1 - 2012/8

N2 - We report a systematic review and meta-analysis of the peer-reviewed literature focusing on metal sensitivity testing in patients undergoing total joint replacement (TJR). Our purpose was to assess the risk of developing metal hypersensitivity post-operatively and its relationship with outcome and to investigate the advantages of performing hypersensitivity testing. We undertook a comprehensive search of the citations quoted in PubMed and EMBASE: 22 articles (comprising 3634 patients) met the inclusion criteria. The frequency of positive tests increased after TJR, especially in patients with implant failure or a metal-on-metal coupling. The probability of developing a metal allergy was higher post-operatively (odds ratio (OR) 1.52 (95% confidence interval (CI) 1.06 to 2.31)), and the risk was further increased when failed implants were compared with stable TJRs (OR 2.76 (95% CI 1.14 to 6.70)). Hypersensitivity testing was not able to discriminate between stable and failed TJRs, as its predictive value was not statistically proven. However, it is generally thought that hypersensitivity testing should be performed in patients with a history of metal allergy and in failed TJRs, especially with metal-on-metal implants and when the cause of the loosening is doubtful.

AB - We report a systematic review and meta-analysis of the peer-reviewed literature focusing on metal sensitivity testing in patients undergoing total joint replacement (TJR). Our purpose was to assess the risk of developing metal hypersensitivity post-operatively and its relationship with outcome and to investigate the advantages of performing hypersensitivity testing. We undertook a comprehensive search of the citations quoted in PubMed and EMBASE: 22 articles (comprising 3634 patients) met the inclusion criteria. The frequency of positive tests increased after TJR, especially in patients with implant failure or a metal-on-metal coupling. The probability of developing a metal allergy was higher post-operatively (odds ratio (OR) 1.52 (95% confidence interval (CI) 1.06 to 2.31)), and the risk was further increased when failed implants were compared with stable TJRs (OR 2.76 (95% CI 1.14 to 6.70)). Hypersensitivity testing was not able to discriminate between stable and failed TJRs, as its predictive value was not statistically proven. However, it is generally thought that hypersensitivity testing should be performed in patients with a history of metal allergy and in failed TJRs, especially with metal-on-metal implants and when the cause of the loosening is doubtful.

UR - http://www.scopus.com/inward/record.url?scp=84864646813&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=84864646813&partnerID=8YFLogxK

U2 - 10.1302/0301-620X.94B8

DO - 10.1302/0301-620X.94B8

M3 - Article

C2 - 22844057

AN - SCOPUS:84864646813

VL - 94 B

SP - 1126

EP - 1134

JO - Journal of Bone and Joint Surgery - Series B

JF - Journal of Bone and Joint Surgery - Series B

SN - 0301-620X

IS - 8

ER -