summary TKA Metal Hypersensitivity is a complication of TKA that may lead to persistent knee pain and stiffness as a result of an allergic reaction to the metallic components. Diagnosis involves careful patient history, and ruling out infection or aseptic loosening. Patch testing may be helpful in diagnosis. Treatment generally involves component exchange to a hypoallergenic femoral component with all-polyethylene tibial component. Epidemiology Incidence rare Etiology Pathophysiology Type IV - delayed-type cell mediated hypersensitivity mediated by T cells reaction to nickel found in cobalt-chromium alloys metal ions deposit in local tissue, must react with proteins to initiate hypersensitivity biggest link may be metal ions/hypersensitivity as a causative initiator of early implant loosening Presentation History may have history of dermatitis, eczema, other signs of atopic hypersensitivity Symptoms vague persistent pain persistent, unremitting effusion/swelling stiffness Physical exam document range of motion Studies Evaluation patch testing (limited evidence for direct link to diagnose hypersensitivity) lymphocyte transformation test (LST) T-lymphyocyte rich immunohistopathology negative work-up for chronic/acute infection (must be ruled out) Diagnosis exact definition is controversial some argue combination of a positive patch test, positive immunohistopathology, and relief of symptoms upon implant exchange is only way to confirm diagnosis others argue that metal hypersensitivity is a diagnosis of exclusion, only arrived upon when infection and aseptic loosening is ruled out Treatment Operative implant exchange indications persistent symptoms affecting quality of life technique hypoallergenic femoral component with all-polyethylene tibial component if possible at time of surgery, chronic inflammatory synovitis typically present
Technique Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. TKA Revision Orthobullets Team Recon - TKA Patellar Prosthesis Loosening Technique Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. TKA - Parapatellar Approach Derek T. Bernstein Stephen Incavo Recon - TKA Patellar Maltracking Technique Guide Technique guides are not considered high yield topics for orthopaedic standardized exams including ABOS, EBOT and RC. TKA - Varus Knee with Anterior Referencing and Gap Balancing Technique Derek T. Bernstein Stephen Incavo Recon - TKA Axial Alignment
QUESTIONS 1 of 2 1 2 Previous Next Sorry, this question is for PEAK Premium Subscribers only Upgrade to PEAK This is an AAOS Self Assessment Exam (SAE) question. Orthobullets was not involved in the editorial process and does not have the ability to alter the question. If you prefer to hide SAE questions, simply turn them off in your Learning Goals. (SAE13BS.7) A 62-year-old woman has advanced osteoarthritis of the knee that has been refractory to nonsurgical treatment. She wishes to discuss total knee arthroplasty. She reports a lifelong history of intolerance to most jewelry and is concerned about having an allergic reaction to the metallic knee implant. Hypersensitivity to metal implants is usually classified as what type of Gell-Coombs reaction? QID: 8308 Type & Select Correct Answer 1 I (allergic) 5% (53/1086) 2 II (cytotoxic, antibody-dependent) 2% (27/1086) 3 III (immune complex) 6% (63/1086) 4 IV (delayed type) 86% (929/1086) L 1 Question Complexity D Question Importance Select Answer to see Preferred Response SUBMIT RESPONSE 4 Review Tested Concept Review Full Topic
All Videos (3) Podcasts (1) Login to View Community Videos Login to View Community Videos ICJR 9th Annual Revision Hip & Knee Course Metal Hypersensitivity: Current State of Evaluation and Management - Ran Schwarzkopf, MD Ran Schwarzkopf Recon - TKA Metal Hypersensitivity 8/24/2022 57 views 4.0 (1) ICJR 8th Annual Revision Hip & Knee Course Metal Hypersensitivity in TKA: Current State of Evaluation & Management - Cory G. Couch, MD Cory Couch Recon - TKA Metal Hypersensitivity 5/13/2022 456 views 4.0 (1) 2018 Orthopaedic Summit Evolving Techniques Evolving Technique Update: My Knee Never Felt Good, It Is My 1-Year Check Up: I Read On The Internet The Facts, I Am Allergic To My Implant Doc - The Truth About Allergies To Metal - Michael Bolognesi, MD (OSET 2018) Michael Bolognesi Recon - TKA Metal Hypersensitivity C 7/25/2019 1208 views 2.8 (5) Recon | TKA Metal Hypersensitivity Recon - TKA Metal Hypersensitivity Listen Now 6:41 min 2/27/2022 117 plays 0.0 (0)