Metal allergies!

[1ELISEA]

I am going though some similar things

Hi @tennis bum
(and thanks @Pumpkln )
There is no need to suffer waiting for a TKR today, there are alternatives. Studies show that those that are highly reactive to nickel, and may have had issues from a previous implant, a nickel free implant can mean a successful revision. Waiting for new materials to be offered may be a long wait.

I have major metal allergies as I mentioned previously in this thread. It has been 18 months since my TKR and so far so good. I was way beyond cortisone shots working effectively; it was wheelchair time.

As I am the poster child for allergies to everything, and have been for all of my life, I pursued my own intensive investigative study of TKR materials. I am highly reactive to nickel, chromium, cadmium, titanium dioxide, bone cement, and several others. There are very few that have as many reactions to metals as indicated on the test than I, so if you have any questions, please ask.

Because of my nickel and other metal allergies, I have the Smith and Nephew implant which contains no nickel and is made of zirconium. Also, the coating is not a coating as we usually think about it; it is created during the manufacturing process and so is part of the metal, not an additive after manufacture and does cover the entire surface. Not sure who told you differently but that is indicative of the lack of information on the subject.

There is actually a considerable lack of information about reactions to metal and implants as it has not been studied in depth. Plus, the internal allergic reaction is completely different than from an external/ dermal reaction. The usual skin test for an allergic reaction is ineffective; rather a blood test is a better indicator of potential problems. I worked with my Allergist and would suggest the same to you; work closely with an Allergist or Rheumatologist MD, they are the specialists in this field rather than an orthopedic surgeon.

My one concession was having one rather than two knees done. I had a TKR on the worst, even though they were both in bad shape. If in another 2 or 3 years I continue to do well, I probably will have a TKR in the other knee but I can report that I am doing fine.

Personally, putting my life on hold any longer would have led to a much less enjoyable life. And life is really way too short. I can now walk without a limp and people no longer look at me funny, analyzing my gait to attempt to figure out whether it is my hip or knee causing problems.

No more unsolicited advice from strangers about different natural remedies that will heal my knee, or tell me there are riding scooters available in the front of the store, or compare me to their relative with medical problems, or even how to get a handicapped sticker for my car.

Now I can hike, stand on one leg, pivot quickly without my knee collapsing, twist, sleep without a painful knee, drive for hours without collapsing in pain, walk the length of an airport terminal without dying many times over in severe pain, stand in queues / lines waiting with others, and my gastric ulcers have healed after long term NSAID use.

For me, the chance of living a normal life outweighed my fears of possible reactions. Each of us needs to decide for ourselves, but hopefully my journey has helped add to your knowledge.
All the best and as I mentioned, if you have questions, please ask.

 

[spinfanatic]

This is such a timely reopening of a thread. I am having revision on Thursday due to cobalt and nickel allergy. My surgeon is replacing my cobalt chromium implant with a GenesisII Smith and Nephew implant that uses an Oxinium femoral component and titanium metal backed tibial component. @1ELISEA is this the implant you have? Your story has me so excited and more confident than ever in my decision to go forward with revision. @tennis bum and @CatD keep an open mind and don't loose faith. This medical stuff makes my head spin but I am thrilled that I found surgeon after much to do who is very confident in diagnosis and implant.

 

[Josephine]

Braun also does a Zirconium knee as well broken link removed: https://www.bbraun.com/cps/rde/xchg/bbraun-com/hs.xsl/products.html?prid=PRID00004602

 

[busylizzie]

@Josephine do you know anybody that has had a Braun knee fitted or have any independent reviews of the system. It looks interesting and seems able to be fitted without cement which the Smith and Nephew oxinium system can't be. i'll certainly be doing some research on it as a possibility especially if it turns out I have a problem with bone cement as well as the metals.

 

[Josephine]

I didn't get the impression it was uncemented, lizzie. I wouldn't advocate uncemented knees anyway - they have a tendency to come loose a lot more than cemented ones. But I only just spotted the ad in this month's Journal of Bone and Joint Surgery. So sorry but no, I don't know anyone who's had one!

 

[busylizzie]

I've looked again and the long extension stems for a revision can be cementless. But what do you do if you have a bone cement allergy?

 

[1ELISEA]

But what do you do if you have a bone cement allergy?

My tests show me as very sensitive/allergic to bone cement. My other recourse, though, was a wheelchair if I didn't go ahead with it.

So had a lengthy discussion with my Allergist regarding it; he thought I would be ok because the cement is in a powder form when used for determining a sensitivity/reaction. Once it is in a hardened form its property changes.

Though it is one of the reasons I've only done one TKR. In another few years, if everything continues to be well, I'll consider the other knee.

 

[busylizzie]

@1ELISEA, thanks. I have had my original TKR removed over 10 weeks ago. It was an oxinium knee due to Cobalt and Chromium allergies. The Cobalt one is +++. It had never been right since the op in November 2011. I have continued to have the pain swelling and warmth since it was taken out but all I have in my knee is a non-articulating antibiotic loaded spacer. I suspect the cement in the spacer may be reacting.

I am going in hospital next Monday to have a piece of tissue removed from under the spacer and yet another aspiration in the hope that they can discover the cause of the problem. Then, I will be able to move forward and hopefully have a new knee, (stage 2 ). The consultant still hasn't ruled out the possibility of an infection but all tests so far have come back negative with the exception of a white blood cell scan. The scan can also show up inflammation as well as infection.

As regards a wheelchair, that is what I'm using at the moment outside the house. I have one with a left leg raise. I have been on crutches 4 years this June and it takes a toll on my arms as I have carpal/ulna nerve problems and fibromyalgia. I bought a mobility scooter last summer but I'm unable to use it due to my straight left leg.

 

[Josephine]

The bone cement, methyl methacrylate, is supplied as a packet of powder and an ampoule of liquid.

The powder is mainly a bulking agent and a platform for the methacrylate. The fluid is the methacrylate and when mixed into the powder, undergoes a thermochemical reaction. This causes the mix to progress from a liquid similar to single cream, to double cream and then to well handled plasticine and which point it is inserted into the body.

Now during this curing period, which lasts about 4-5 minutes, it gives off a very pungent aroma which can be a hazard to operating room staff as it can cause occupational asthma. The free powder is also considered a respiratory risk. While the semi liquid and then pliable mix can permeate the latex gloves and cause contact dermatitis. Some staff are found to be more sensitive to one or other of these hazards than others. I've mixed thousands of doses of bone cement and never had a problem. In fact I quite liked the pungent aroma and miss it still!

Special vacuum devices, mixing bowls and syringes, were developed with which staff could mix the cement without being exposed to either the powder, the vapour of the mix and these were generally accepted as being good practice for staff as according to Health and Safety Regulations in 1980-something. Son bone cement is certainly a sensitivity issue for theatre staff.

Now once the mix has proved enough to be inserted into the bone, it has already stopped emitting the vapour, and the powder, being encapsulated within the mix, is now neutralised from being an exposure hazard. After another 5 minutes or so, the mix becomes hard like marble and is no hazard to anyone. It is inert and harmless and stays thus forever. So for the patients, the risk factors are almost 0 - probably about 0.001%!

 

[1ELISEA]

Hmmm..... I may have mixed up my powder and liquid but inert and harmless; yep, sounds like what my Allergist told me. Thanks for the details! @Josephine

 

[busylizzie]

Thanks, I will wait for Monday and see what results come back. I hope that they will find out what is happening to still cause the pain and swelling.

 

[JonahPro]

Hello Poof. I wish you the best on your LTKR coming up in just a few days. I had a LTKR as well just 11½ weeks ago. My 12th surgery but my first knee replacement. A total shoulder two years ago was one of the 12 surgeries.

Keep us posted. As you know this is a great place to hang out, share experiences and ask questions. Most folks here are very encouraging. As my son told me the last time I saw him prior to my knee surgery, "See you on the other side!" I'm sure you will do fine.

 

[Josephine]

Hmmm..... I may have mixed up my powder and liquid

No you didn't. What the allergist meant by this ..

my Allergist [said] the cement is in a powder form when used for determining a sensitivity/reaction. Once it is in a hardened form its property changes.

.. is that they take the hardened mix and grind it up into a powder and that's what they use for the testing. And s/he was absolutely correct that in that form, the cement has different properties to what it is before it's mixed. Most of the allergy reports posted around are actually referring to staff allergies, not patient allergies. Two different issues.

Another group of workers I forgot to add was dental technicians who use this stuff by the bucket load making dentures. And they don't record much in the way of allergic responses either occupational asthma or contact dermatitis. Mind you, they do work with highly vented cabinets when they're mixing it!!

 

[sktsinger]

Hi - new to this forum. Have needed a TKR for quite some time; first was told that I was too young, then when I got "old" enough I got interrupted by some cancer. (All clear now ) - Surgery was scheduled but has been put off for many reasons, the latest being that I mentioned I break out from costume jewelry and it was decided I should get LTT testing. However, that has been a MESS - got the kit from Chicago but no one is willing to draw blood and put it into someone else's equipment. Was then told that the hospital here does a similar testing, so went and got my blood drawn. They ran the wrong tests! My surgeon has decided - and I am inclined to agree with him - to order the oxinium (sp?) knee rather than keep me waiting even longer. Thoughts?

 

[tennis bum]

Sktsinger. good luck. glad u r clear now too. I would do some patch testing since you can not get the blood test done. just as a good back up. I did not know prior to the 1st knee i had an allergy to nickel.

 

[Brownber]

I was at the hospital, seen anaesthetist, bloods taken, leg marked and tagged for TKR and with surgeon signing consent form, when the previously disclosed jewellery allergy was highlighted again. Result is surgery was cancelled (I was already two months later than promised) and I am being sent for allergy testing. Disappointed and frustrated but better that than have something in my leg that my body fights with!. Just hoping that NHS economics wont stop me from getting a suitable implant. Anyone else with metal allergy and NHS experience?

 

[busylizzie]

Hi @Brownber, welcome. I'm not so far away from you in the North West of England. It's frustrating getting so far and having the op cancelled. If you do have a nickel allergy (common with jewellry allergy) there is an oxinium knee available. The top piece is made out of zirconium and the tibial bit titanium. I haven't heard of anyone having trouble getting it on the NHS despite it costing more. My original Knee was an oxinium one as I had cobalt and chromium allergies. Just hope there isn't a long wait for the patch testing I assume they will be doing and you get rescheduled soon. Keep in touch.