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Metal allergies!

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Hi All,
I have now gone to 3 OSs regarding my blood tests showing I am allergic to Nickel and Titanium. Bottom line, no go on any joint replacements until new products come on the market. It was worth it to pay out of pocket initially for the blood tests. Insurance did reimburse me. Workup done at Rush in Chicago. My opinion....get tested! Cat
 
CatD,

Would you mind sharing with us the type of blood testing that you had done? Was this a rheumatologist who oversaw this?

Orthodoc
 
Orthodoc. I didn't know that people could be allergic to Titanium. I assumed it is a pretty inert substance in the body. Can folks really be allergic enough to it to have an adverse reaction?
 
I asked my OS if there was some kind of blood test to determine for sure, which knee implant would be the best for me. He ordered an Orthopedic Analysis. It is called a METAL-LTT. The blood was taken to a lab in Chicago. No other lab in the area could do these tests. I had 2 panels done, one for metals and one for bone cement. And yes, I tested mildly reactive to Titanium. As my surgeon said, once my own joint was removed, there would be no turning back, I COULD forever face complications not only with the knee, but my overall health as well. Not worth the risk. My brother has had 3 knee replacements and still has many problems with his knee. I believe that the surgical metal testing should be a mandatory test for anyone considering any kind of implant, including dental!
 
By the way, the only indication that I had a metal allergy was that I could not wear cheap pierced earrings and sometimes the snap on jeans at the waist would leave a reddish mark. Never a rash or other obvious sign.
 
Hotsalsa64 said:
Hi, I have had a full knee replacement and spine surgery in the last two years. I never even thought about having metal allergies until recently. My knee never healed, had stayed in pain and warm to the touch. I had a back issue come up right after my knee replacement so I've been in constant pain. My knee replacement was done 12/2010 and my spinal surgery on 3/12. It wasn't until my back surgeon suggested I might be allergic that I started reading up on it. I'm only 52 and hope I can fix my knee. The hardware for my back can come out after 18 months. I think testing should always be done.
Click to expand...
Hotsalsa - I had a revision 2 years ago and I'm still not healed. I just had another MRI and was diagnosed with synovitis but nobody seems to know why it happens or what to do about it. My knee is always very swollen and warm to the touch, but no infection. My ROM is not even 90. If anyone is getting any further information on Synovitis post TKR, I would love to hear from you.
 
CatD,

Thank you for the response.

Titianlady,

True titanium allergies are much less common than allergies to nickle. However, I have read some studies that seem to show this type of allergy in patients with dental implants. This is a field of interest that just hasn't been studied enough in my opinion.

Orthodoc
 
CatD, did your surgeon bring up the ceramic knee implant? There is no metal in them. The Oxinium knee just may work for you.
 
Smith & Nephew has had a unique femoral surface for many years that is ceramic on the surface (proprietary name is "Oxinium"). The femoral component is a metal with a few millimeters of ceramic on the surface (integral material not a layering of different material). A smaller company (Vega?) has a layered femoral implant with a ceramic surface.

The question for the experts is does this matter with the tibial base, femoral screws, etc., all of various metal materials aforementioned?
 
I have bad reactions to earrings and metals. The first OS told me the Smith & Nephew was the answer and it was. When I had my revision, they would only consider Smith and Nephew again. I am glad. Enough of a ride without having reactions to them! :happydance:
 
Prior to my TKR last year, I also underwent the Lymphocyte Transformation Test (LTT) to determine metal sensitivities (aka metal allergies) and then met with my Allergist MD

I encourage anyone who does get tested to work with an Allergy or Rheumatology specialist rather than interpreting results on your own. My sensitivities to metals are many and we examined each reading and discussed them in depth to determine which might be an issue with an implant.

I also had a reaction to bone cement, in powder form which is what was tested. However, the bone cement hardens to solid form when used for the implant. After discussion with my Allergist, we decided this would be ok.

If I was looking for a reason not to have a TKR, metal sensitivities would have been the roadblock. My choice then would have been heading to a wheelchair. Instead, I used the information gained to find a surgeon and a nickel free implant..

There is no 100 % certainty in life. I did my research and investigation, consulted with the experts, and then took the leap.
 
Good to hear this--my husband's knees are deteriorating and he's been planning to get TKRs when he retires (much of his day is spent standing up in cardiac cath labs and taking multiple flights of stairs). But he is highly allergic to nickel--so much so that he cannot wear wire-rimmed glasses unless they're either titanium or 14K, otherwise he gets terrible contact dermatitis.
 
I am so grateful to those of you who have raised the issue of metal allergy. Because I react to certain jewelry and because of what you have shared here, I thought it wise to seek a consult. I also react to certain products used in the environment as well as to a few meds but am assuming these sensitivities are a separate issue. The allergist MD I saw will do a skin test of about 80 materials including the metals used in the Zimmer NexGen. They place the 10 patches one day, two days later take the patches off, and two days later do a final reading. I am wondering if this is sufficient after reading 1Elisea's recommendation for an LTT blood test instead.

When I raised the issue about metal sensitivity with my OS he said in all his years he has never had a patient with a problem. (He's an experienced and top surgeon only doing knees and I think hips.) However, I am wondering if he would know since it can be a rough diagnosis to make down the line post op, occurring as the implant breaks down gradually sending its material into other tissues.

Does anyone know if I am ok with the skin tests or should I look further into the LTT blood test? :spin: Time is quickly drawing nigh---April 29th.
 
Hi kraaygal
I consider myself part of a very small subset of the population, "the less than 1%", in having had very severe allergies all of my life so I tend to give them my full attention, whenever possible, prior to any medical event I may be having. And that included metal hypersensitivity reactions prior to my TKR. It does surprise me that an Allergist MD would be performing a skin test rather than an LTT test for a TKR but perhaps that is indicative of the lack of information on the subject.

There have not been a lot of studies yet on the subject but Orthodoc Orthodoc as you may have read, has attached several informative articles on the subject that explain metal sensitivities in more detail.
Here is one: broken link removed: https://jbjs.org/data/Journals/JBJS/829/JBJA083030428.pdf

I also found an article printed on the website of the American Academy of Orthopaedic Surgeons on the pros and cons of the various testing methods, dated Sept 2012.
broken link removed: https://www.aaos.org/news/aaosnow/sep12/research3.asp

An excerpt:
Testing problems
The following problems associated with skin patch testing of patients undergoing implantation of a metal device should also be considered:

Subjectivity: Interpreting the +1 to +3 dermal reaction results is subjective and far from optimal, given observer biases.

Cell locations: Antigen-presenting cells (Langerhans cells) within the skin layers do not react in the same way as macrophages and dendritic cells located in the deep tissues around the implant. This calls into question the results and correlations to orthopaedic implant performance.

Sensitization: Perhaps of most concern for orthopaedic surgeons is that patch testing involves mixing metal chlorides in petroleum jelly and applying them to the patient’s skin for at least 48 hours. The same phenomenon (T-cell response) that provokes a response can theoretically induce sensitivity in people (as it has been shown to do in animal models). Although a minimal risk, it is consistently mentioned in the literature on the topic. The interpretation of skin patch testing results should be considered only in the context of the history, physical examination, and results of other diagnostic testing modalities.
Hope this information is helpful.
 
Thanks 1Elisea! :goodpost:Very helpful. I am seeing reports that say that pre testing with either skin or LTT isn't a reliable predictor. Plan to dig more into the research tonight. You were so smart to get ahead of this and shift to an implant that did not have nickel. Looks like you have done well.....feeling like your own knee almost a year down the road? Thanks again for your response. Kraaygal (Kraay is the name of my surgeon!!!0
 
CatD,

It appears I am going though some similiar things just a 14 months later than you. I am wating for the tituniam patch to coming in. I did send blood to Chicago. I am negative for tituniam, but postive to nickel. I have been told that Oxinium and ceramics are not an option since nothing is 100% coated/covered. I would love to hear what or if you found any other option.
 
I wiill tag @1ELISEA for you, she can provide additional insite. All the best, you are in the right place.
 
Hi All. So glad that this conversation is taking place. Some OS do not acknowledge that post op problems with joint replacements are a result of allergies to the metals. Problems are sometimes blamed on non-compliancy from patients, improper therapy, weight, infection, etc. My opinion is no one should allow even the best surgeon known to remove your joint without these blood tests! There is no going back. There is a possibility of pain, swelling, synovitis, loss of ROM, the list goes on. I have now been to a Mayo Clinic OS and he could not recommend a brand of joint replacement for me as there are none without something I am allergic to. He said wait a few more years. In the mean time, I am getting the injections 2x a year. Cortisone does nothing. I am sure I am not the only one.
 
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