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The Journal of Bone and Joint Surgery 83:428 (2001)
© 2001 The Journal of Bone and Joint Surgery, Inc.

Current Concepts Review

Metal Sensitivity in Patients with Orthopaedic Implants

Nadim Hallab, PhD, Katharine Merritt, PhD and Joshua J. Jacobs, MD

Nadim Hallab, PhD Joshua J. Jacobs, MD Department of Orthopaedic Surgery, Rush-Presbyterian-St. Luke’s Medical Center, 1653 West Congress Parkway, Chicago, IL 60612. E-mail address for N. Hallab: nhallab@rush.edu
Katharine Merritt, PhD Food and Drug Administration, 12709 Twinbrook Parkway, Rockville, MD 20852
In support of their research or preparation of this manuscript, one or more of the authors received grants or outside funding from the National Institutes of Health. None of the authors received payments or other benefits or a commitment or agreement to provide such ­benefits from a commercial entity. No commercial entity paid or directed, or agreed to pay or direct, any benefits to any research fund, foundation, educational institution, or other charitable or ­nonprofit organization with which the authors are affiliated or ­associated.


   Introduction
 
All metals in contact with biological systems undergo corrosion. This electrochemical process leads to the formation of metal ions, which may activate the immune system by forming complexes with endogenous proteins.

Implant degradation products have been shown to be associated with dermatitis, urticaria, and vasculitis. If cutaneous signs of an allergic response appear after implantation of a metal device, metal sensitivity should be considered. Currently, there is no generally accepted test for the clinical determination of metal hypersensitivity to implanted devices.

The prevalence of dermal sensitivity in patients with a joint replacement device, particularly those with a failed implant, is substantially higher than that in the general population.

Until the roles of delayed hypersensitivity and humoral immune responses to metallic orthopaedic implants are more clearly defined, the risk to patients may be considered minimal.

It is currently unclear whether metal sensitivity is a contributing factor to implant failure.

Implant-related metal . . . [Full Text of this Article]


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