Abstract
No validated screening method exists to identify patients at risk for metal allergy
complications following total knee arthroplasty (TKA). Select use of implants that
do not contain nickel, cobalt, and chromium may be considered in patients at risk.
This study was performed to determine the rate of self-reported cutaneous metal allergy,
or sensitivity, in patients undergoing knee replacement, and to evaluate whether there
is a higher prevalence in females. A retrospective chart review was performed on 194
consecutive patients who underwent primary knee arthroplasty with a single surgeon
between 2010 and 2011. During this period, all patients, except those with a previous
well-functioning orthopedic device, were asked preoperatively about a history of metal
allergy or sensitivity. The prevalence of self-reported cutaneous metal allergy, or
sensitivity, was 14%; 22% (19/86) of females and 2% (1/53) of males reported a positive
history. Fourteen percent of patients undergoing TKA self-identify as having a cutaneous
metal allergy or sensitivity. Until validated screening tests are developed to identify
patients “at risk” of symptomatic metal allergy after TKA, selective use of prostheses
that do not contain cobalt, chromium, or nickel in individuals who self-identify with
metal sensitivity may be considered. As most of these patients are female, manufacturers
should consider optimizing availability of these implants in smaller sizes.
Keywords
metal allergy - total knee arthroplasty - complications - prevalence
