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TKR Allergic to metals and I need advice.

Skybig

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I'm 61 years old and I have been told over the years that I will need a TKR. Well finally I decided this summer that I've had enough pain and discomfort so I decided to go forward with it sometime in the Fall. On my first appointment with my Knee surgeon I mentioned that I may have a metal allergy because I can't wear a watch without getting sores on my wrist. So he had my blood tested by Orthopedic Analysis in Chicago to see what if any metals I'm allergic to. Well the test came back and it turns out I'm "allergic" to a lot of metals. It said that I'm "Highly Reactive" to Nickle, that I'm "Reactive" to Vanadium and "Mildly Reactive" to Aluminum, Chromium, Molybdenum, Zirconium. It also says that I'm okay with Cobalt and Titanium. Apparently that severely limits a lot of the knee replacements. My surgeon did say that there is a knee replacement made from Titanium, but it has wear issues.

Has anyone faced similar issues?
 

Celle

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Hello @Skybig and :welome:

I'm glad your surgeon had you take the blood test for metal allergies.

Although there are many brands of knee replacement that would not be suitable for you, Smith and Nephew make one that is suitable.
There isn't a lot of difference between one brand of knee replacement and another and I believe the Smith and Nephew one works well.

We do have people on BoneSmart from time to time who have a metal allergy. Some even had an initial replacement and then discovered their metal allergy. They then had to have their surgery revised, to install a type to which they were not allergic.
 
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Skybig

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Smith and Nephew make an interesting knee replacement but according to their literature they use a Cobalt-Chromium alloy and according to the Metal-LTT analysis I'm allergic to Chromium. Of all the metals tested, only Cobalt, Titanium and Iron seemed okay. So having non-allergic metal really narrows down the potential knee replacements for me.

I also tried in vain to get into one of many on going meniscus trials over the years. Most of the trials knocked me out at the initial screening because my issue is more on the lateral side of my knee. They all told me that my best option is a TKR and now it seems that option is fading fast.
 

Celle

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I don't know what other options there are for you, but I'm going to ask my colleagues. I'm sure there is a prosthesis that will be suitable.
 

Jamie

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You may need to look around for a surgeon who is experienced with the particular implant you may need. The Smith and Nephew Oxinium knee is a possibility. Although it does have a trace of nickel, it has been used successfully for a number of our members with metal sensitivity.

Another really good option is the Gold Knee made by Aesculap.

Please don't despair about the possibility of getting a knee replacement. There are options and you just need to search out the right surgeon who is used to working with those systems and with patients who have metal sensitivities.
 
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Skybig

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I looked into the Aesculap Gold knee and it looks interesting as do the other Titanium Nitride (TiNbN) coated knee replacements. The Titanium Nitride locks in the other metals so they can irritate or aggravate my metal allergy. How long to these coating last? Does anyone have one or know of someone who does?
 

Celle

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How long to these coating last?
I would expect the coating to be bonded onto the prosthesis, so the whole thing lasts as long as any other knee replacement hardware.

We do have someone who finally received an implant suitable for people with metal allergies, after having a series of failed replacements. It took quite a while for metal allergy to be diagnosed as her problem.
Her thread is here:
https://bonesmart.org/forum/threads...ont-settle-thats-me-bonnie.10146/post-1385287

She isn't on the forum very much nowadays, but I will tag her, hoping she responds.

@RunA42K - Please can you talk to Skybig about your latest knee replacement?
 
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Skybig

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My surgeon suggested that a Smith and Nephew OXINIUM knee replacement may bet my best option right now. This has me concerned because isn't OXINIUM basically just Oxidized Zirconium? Well my Orthopedic Analysis report says that I'm "Mildly Reactive (Stimulation Index 2.4)" to Zirconium. Sounds odd to me unless my body doesn't see the Oxidized Zirconium ceramic coating the same way as it does straight Zirconium. Does the oxidation process somehow insulate or alter the Zirconium so I'm not allergic to it???

My surgeon also claims there are no FDA approved Titanium Nitride knee replacements that he can use. I'm not sure what that exactly means. Does anyone know if any of the Titanium Nitride (TiNbN) coated knee replacements are approved for use in the United States? I went on the Aesculap web site and their Gold knee is not sold anywhere near me. They seem mostly sold out west and I'm in NY State.
 
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Celle

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I think you're getting too technical for me!

Your surgeon has more training in the various types of knee replacements than we do and you should probably discuss all this further with him - or with another surgeon for a second opinion.

I can't see why the Aesculap Gold knee couldn't be sold in New York state, just because it's mostly sold out west. It's all one country, isn't it?

Is your surgeon affiliated with one of the big, specialist hospitals in New York? They might be a resource for you, since you have a rather unusual problem.
 

lovetocookandsew

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I'm one who had a revision due to metal allergy, and my surgeon used an Aesculap knee implant to avoid another reaction. The pain I had in my knee before my revision is totally gone, so the knee implant itself worked as we hoped. It's been going on 2 1/2 years now, and the implant is causing no problems. I'd ask my surgeon specifically about the Aesculap as he may be able to get it from his rep-that's what mine did as it wasn't one he was using at that time.
 
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Skybig

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Like the Smith and Nephew OXINIUM the Aesculap knee implant also uses Zirconium (which I'm supposedly mildly allergic to) in the form of Zirconium Nitride, so I have the same sort of question with it as I did with Smith and Nephew knee replacement. Does the Zirconium Nitride do something to the Zirconium that makes it non-allergic? Unfortunately, my doctor isn't a Metallurgist, so he can't really answer either question. I know because I asked already and he didn't know. I'd be willing to bet that an engineer who works for either company would be able to answer all off my questions that is.........If the lawyers allowed it, which I'm sure they won't. So I'm basically between a rock and a hard place and the FDA doesn't care.
 

Celle

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Well, we're not metallurgists either, so we're as stumped as your surgeon.

All I can tell you is that these special knee replacements have been used a lot. We've had people here on BoneSmart with them and none of them have experienced any problems with proving allergic to the special implant.

I guess it all depends on how bad your knee is, how much pain you are in, how much more pain you can stand, and whether you are willing to take a very, very small chance that you will be mildly allergic to a special knee implant.

The choice is yours and, unfortunately, we can't give you any more technical details to help you decide.
 
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Skybig

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Well I agree that you folks aren't metallurgists and I wasn't actually asking or even expecting you to answer those questions. I was merely restating the questions that I've already asked multiple companies over the past few months. They are the ones who SHOULD know and probably do the answers, but remain silent. They remain silent for one reason..... and that's probably money!

I don't know how you or my Surgeon can say that I would be taking "a very, very small chance" going with either of those knee replacements because the test showed that I my blood had a mild reaction to Zirconium, along with just about every other metal in the report (Only Cobalt and Titanium are okay). So odds are I would have some sort or negative reaction, but no one knows the magnitude of it or even how it will manifest itself. I do know this, once I go forward there is no turning back and there are no other FDA approved implants to fall back on. So if I do get a reaction I'm living the rest of my life with it and I'm not willing to take that risk. The really sad part in this whole saga is that there are knee replacements made that would be hypoallergenic for me, but none of them that I'm aware of are approved for use in USA. Obtaining FDA approval takes about 8 years to obtain and for many companies its not worth the effort.

Its been almost 20 years since since my initial knee injury and at least 15 years since I was told that my knee needs replacing now. I guess I'm just one of the "Lucky ones" who will have to explore other less pleasant options.

Thanks
 

Celle

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I don't know how you or my Surgeon can say that I would be taking "a very, very small chance"
I think that's the result of practical experience. BoneSmart has advised people who had these implants and none of them we encountered experienced a problem.
I think the surgeons who install these special knee implants will have seen more patients with metal allergies than we have and amongst those people the incidence of reactions has been very low.
 
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Skybig

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I'm just very frustrated with my situation, so I apologize if I've come off nasty or condescending. Its just that I've been waiting so so long to be finally pain free only to hit yet another snag.

For what its worth, today I spoke with someone at the testing lab and they basically confirmed what you've stated above. Especially with Zirconium, since my results were just above normal.

I'm going to let all this soak in a few days before I decide which way to go. If only my insurance would insurance would cover it, I'd run off to Germany and get it done there using a one of their Titanium Niobium Nitride knee replacements.

I really do appreciate yours and the others input here.
 

Celle

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You haven't come over as nasty or condescending at all - just worried, stressed, possibly over-thinking, and in pain. :friends:

I'm just sorry we can't help you more.
 

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