Allergy Testing - forum discussion

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Apr 12, 2013
Agoura Hills, CA
United States United States
I want to let everyone know that Medicare approved my bone cement and metal allergy testing with Orthopedic Analysis in Chicago, IL. They paid 100%. Please don't not have the testing due to cost. To have an implant installed in your body that you are allergic to is no joke indeed. Many people are allergic to nickel and nickel is in almost all implants except the Smith and Nephews Oxinium knee. It turned out I was allergic to several metals so it was a blessing that I had the testing done.

Here is how I was able to get it covered. First I went to my family doctor. He wrote a prescription for the allergy testing and put the codes on the prescription. I submitted that prescription with my paperwork to Orthopedic Analysis. They billed Medicare. It took six months for it to finally clear, but I was delighted that it was covered in full even though Othopedic Analysis had me sign a form that I understood it probably would not be covered and that I would have to pay for the testing if it was not covered.
Good news for you! Thanks for sharing this information. I am sure others will find it helpful.
Very good post. The medical community is learning more and more each year about this procedure. Over 700,000 TKRs are done each year. We are discovering better ways to perform the operation and improved parts. Allergy testing will come more routine in the future. I am always surprised when I learn that people that are going to have an operation that is going to improve their quality of life, will opt out to have a test or purchase an item that will give them a better outcome. They will go over buying a car or a TV with a fine tooth comb, but fail to put the same investigation into having their knee replaced.
I was recently at a large international conference on joint replacement surgery and the topic about metal allergies was discussed. Unfortunately, there were no significant advances in diagnosis or treatment algorithms presented. Hopefully, this area of research will continue to receive more attention.

Thanks for the post. I actually went out of pocket for these tests. These blood results state I am highly sensitive to nickel (patch test after 1st RTKR reaction verified this) and do not react to titanium. However, with the 2nd RTKR I now have a 100% titanium part in me (3-5% alloys). Am I am reacting to this knee too! Allegry tests so far are negative to titinium, cement glue, etc .... only NICKEL! Titanium and alloy patches are on order. Any suggestions? Doc states he does not have a current option for a 3rd RTKR composite.
@tennis bum

I also have allergy problems. I had an oxinium L knee replacement in Nov 2011. Oxinium was used as I had a known allergy to Cobalt metal (now know Chromium as well). This replacement wasn't successful and resulted in a great deal of pain and swelling with limited function. This was revised in Aug 2012 due to the surgeon thinking he had put a metal ring on the patella button and I was reacting to this- not true. This last Nov i have had the knee removed and now have a non-articulating antibiotic loaded cement spacer. I am continuing to get pain and swelling despite this and my surgeon is unsure of the way forward. I'm waiting for a tissue sample to be taken from next to the spacer to see if I'm reacting to the bone cement. I too test OK for Titanium. I'm interested in anything you find out.
@tennis bum. I am having revision next week due to cobalt/nickel allergy and will be getting a Genisis II: Smith and Nephew implant. The implant uses a Oxinium femoral component and titanium metal backed tibial component. I wonder if this is the implant @busylizzie had? Yikes! In terms of testing my surgeon who is at HSS in NY and written on the topic prefers patch over blood testing. Good luck. I am hoping second time is the charm!
@spinfanatic Yes it was a Smith and Nephew knee but I believe from what I was told that both components femoral and tibial were made from oxinium. I asked my original surgeon a few times what he actually put in and this was what he told me. What symptoms did you have from the cobalt chrome knee?
Hi @busylizzie. My symptoms are chronic stiffness and swelling....a big fat knee. I still have pretty good bend after I stretch and can walk ok. Stairs are big issue and I live in a vertical world. My revision surgeon has done a bunch of these allergy based revisions and although can't offer any guarantees believes my situation is "the real thing". My original HSS surgeon who has done over 3000 TKRs has never had a patient react negatively to implant due to allergies. Guess we are special! I have followed your thread and am amazed at how much you have been through all the time maintaining your cool. I hope you find success in this go round.
@spinfanatic stairs have always been a problem with me. Since the bone on bone pain started almost 4 years ago I haven't been able to do stairs down one foot on each step. I've been on crutches since then. Going up before the first op I could do OK but have really struggled since then. Recently we have thought about a stair perch lift but are leaving it for a while. I go up and down the stairs anything from 2 to 4 times a day. When it gets to 4 i decide it is bed time and I go back upstairs and stay up there until the next day
Guys... thanks for making me feel better. I am sorry this is happening to you all as well.

I have been told oxinium it not an option since it is the titunian that is not covered/coated.

I will post again when I know the results of the pending patch tests and/or if I get in to see the specialist at HSS in NYC! I sent HSS over 50 pages of my records.
@tennis bum yes please keep us posted.

From what i've been told patch testing does not always correlate to tissue reactions. I have wondered about lymphocyte transformation tests (LTT). What reaction did you have to the 2 knee replacements? For me it has been the pain, swelling and lack of function. It is very difficult to get anyone I've met over in the UK to take knee replacement allergy seriously. At least my current surgeon is keeping an open mind although he still thinks I may have an elusive infection. The symptoms are very much alike. I hope I get the tissue sample taken and tested soon. I will keep in touch with this thread.
From what I have read and from personal experience, patch tests do not give accurate results and it is basically a waste of time to have a patch test done. The LTT test is the only way to be sure about metal allergies. I had the patch test as well and it came back negative. I had the LTT test and it came back strongly positive. I then decided to have a third test from a lab in Colorado Springs. Both the Chicago and Colorado Springs blood test results came back strongly positive. I am sensitive to many substances so I felt going the extra mile was worth it. Allergic reactions are no joke indeed. I wish you all the best tennis bum. I too was an avid tennis player. Perhaps that is why our knees gave out in the end. Keep us posted on your progress.
I know it might be costly but I would consider having another test done since it is possible to develop a sensitivity over time. You may have tested negative before the implant but have developed an allergy after the surgery. If it were me, I would go for both the bone cement and metal LTT test through Orthopedic Analysis in Chicago.
I am having the blood test for metal allergies done with Orthopedic Analysis. I talked with the company and they supplied me with a code to check coverage with my insurer carrier (Medicare). I talked with Medicare twice, gave them the code and they told me both times that that blood test is not covered. Any suggestions? Thanks.
I wish I had kept the codes my family physician gave me because mine was covered 100% by Medicare and my Medicare supplement. I suggest that you either go to your family doctor or an allergist and have him/her give you an order and the codes for the allergy testing. I would not rely on the billing clerk from Othopedic Analysis for these codes. They make more money if it isn't covered so they are not going to help you code a test. After your doctor has ordered the testing and has written the codes and order on a prescription, submit the prescription with the paperwork when you send in your blood sample. I think that your doctor has to order the testing and give the codes similar to when he orders a blood test for Medicare to cover it. Simply submitting the codes on your own would not be acceptable to Medicare just like you can't order a blood test for yourself and get it paid. I know that the codes my doctor gave me were to cover multiple tests. That is about the best I can offer. I wish you luck. Pam
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To clarify, I think the key to getting the test paid by Medicare is if your doctor orders the test. Medicare will not pay for a test you decide to have on your own. They will only pay for medically necessary tests and the only way they can determine a test is medically necessary is if a doctor orders it. My doctor had no problem ordering the test for me because of my history of allergies.
I just ordered my kit. The ortho talked with the implant company and they recommended OrthopedicAnalysis. They used to use patch tests but discontinued them and now do the blood test. My mother and sister both have nickel allergies. Hoping mine comes back negative.
If you have a concern about allergies, I would be tested for allergies to not only the metals but also the bone cement. One can't be too cautious when it comes to allergies because if one is allergic, it can cause severe illness, having to have the replacement removed etc. It really is a small expense to pay to make sure you aren't jeopardizing your health and life by having a substance placed permanently in your body that will make you sick.
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