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TKR Nickel Allergy Confirmed with Blood Test

Golfer1

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Although I had a TKA of my right knee 5 weeks ago, I am placing my post in the pre-op area because it is a big concern for those who think they might have a metal allergy to have it addressed PRIOR to surgery.

For years I have known that I would get a rash from wearing cheap necklaces or itchy, swollen ear lobes from cheap ear rings. I have even had to paint the back of metal watch faces with clear nail polish. When discussing knee replacement surgery with my OS late last year, I mentioned to him that I thought I had a metal allergy of some sort and was concerned about the metal implants. He told me that there was a blood test available to test for metal hypersensitivities and urged me to have it.

Long story short… I contacted a lab called Orthopedic Analysis in Chicago, had them test my blood and found out that I am HIGHLY allergic to nickel. The test cost $398, which was fully covered by my TRICARE military insurance.

I showed the results to my OS and it was a game changer. The implant he WOULD have used on me, if I had not had this allergy, would’ve been a Triathalon Knee made by Stryker. It has nickel in it. Instead, he used a Smith & Nephew implant with a hardened ceramic coating (Oxinium-Oxidized Zirconium) which is the “go to” for patients with metal allergies.

In addition, where he normally closes the incision using staples, he used a self-dissolving Monocryl stitch and surgical glue instead, because STAPLES HAVE NICKEL in them too!

I am SO grateful that I had this blood test prior to surgery. I am fully convinced that my body would have rejected the Triathalon implant and most likely the staples as well.. resulting in most likely another surgery to replace the implant later down the road, after much unnecessary pain and discomfort. I DODGED A BULLET with a simple blood test.

If you suspect that you have a metal allergy, you would be very wise to invest in this blood test through Orthopedic Analysis, even if your insurance plan does not cover the cost. It could change your life. (And, no, this is not a paid endorsement nor do I own any stock in this company!)

So, here I am, five weeks after my TKA. I had a 114° bend six days postop and a 123° bend at 4 weeks postop. Onward!
 

Jaycey

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@Golfer1 Great information. I am sure our members will appreciate this input.

Note that I moved your thread to the post op area as you are indeed post surgery. Our pre-op members will see this information and respond with any questions.

I see you have not been given a copy of our knee recovery guidelines. I'll post them here for you.
Knee Recovery: The Guidelines
1. Don’t worry: Your body will heal all by itself. Relax, let it, don't try and hurry it, don’t worry about any symptoms now, they are almost certainly temporary

2. Control discomfort:
rest
ice
take your pain meds by prescription schedule (not when pain starts!)​

3. Do what you want to do BUT
a. If it hurts, don't do it and don't allow anyone - especially a physical therapist - to do it to you​
b. If your leg swells more or gets stiffer in the 24 hours after doing it, don't do it again.​

4. PT or exercise can be useful BUT take note of these

5. At week 4 and after you should follow this Activity progression for TKRs

6. Access these pages on the website

The Recovery articles:
The importance of managing pain after a TKR and the pain chart
Swollen and stiff knee: what causes it?
Energy drain for TKRs
Elevation is the key
Ice to control pain and swelling
Heel slides and how to do them properly
Chart representation of TKR recovery
Healing: how long does it take?

Post op blues is a reality - be prepared for it
Sleep deprivation is pretty much inevitable - but what causes it?

There are also some cautionary articles here
Myth busting: no pain, no gain
Myth busting: the "window of opportunity" in TKR
Myth busting: on getting addicted to pain meds

We try to keep the forum a positive and safe place for our members to talk about their questions or concerns and to report successes with their joint replacement surgery.

While members may create as many threads as they like in a majority of BoneSmart's forums, we ask that each member have only one recovery thread. This policy makes it easier to go back and review history before providing advice.
 

Seatides

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What an informative post, @Golfer1! I wonder why patients aren't routinely asked about metal allergies -- and told why this is so important -- before TKR? Or are we and I've just forgotten? We fill out so many check-off--type forms in advance of surgery; maybe it's on one of those?
 

sistersinhim

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No, it isn't a normal test to have before a replacement. I think it might have something to do with insurance not normally covering it. To me, it makes sense to have the test before hand than having to pay for a revision, but the insurance companies must not think so. Before my next replacement, I will have a metal allergy test will be done, even if I have to pay for it myself. I'd rather know ahead of time rather than go through a replacement because of having the allergy.
 

Sara61

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How very informative- thank you I never even gave that a thought prior to knee surgery nor was I ever asked by anyone if I had a allergy to metal/nickel - I was only given a form asking if I was allergic to food or medicine.
I can only wear/ use gold or platinum so any costume earrings or jewellery is not an option for me.
I will certainly in future inquire about this with my doctor /surgeon.
Wishing a continued good success in your recovery xxx
 
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Golfer1

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Hi Sara61! I was not asked either as part of my preop paperwork. I just happened to know that I was allergic to something in the inexpensive jewelry I was wearing. I knew that I did not want whatever metal that was to be sewn up inside of me! I suspect that most orthopedic surgeons do not routinely ask their patients preop if they might suspect any medical allergies.
 

lilbit

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That is more important than most of us know.
Thank you for posting that for people to at least have a chance to think about.
I had a knee replacement at the beginning of January, 2016. My knee is still extremely stiff and painful. I only have 80 degrees flexion.
The OS said that he had patients with 40 degrees flexion who would be glad to have what I have.
I asked him to refer me to a revision surgeon in one of our larger centres - even gave him the name. My GP checked to find out where I was on the waiting list and was told my name was not on it. So she made a referral. The revision surgeon sent me for blood work. The results showed elevated levels of cobalt.
My knee is a Zimmer Nexgen, but I am wondering if any metal content knee would have given me the same problems. I can't even walk around the block anymore.
 

aries

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I am also allergic to nickel and I had s skin test at the local hospital to check for metal allergies before surgery.The tests showed that I was highly allergic to nickel. As s result I had a replacement that was coated with niobium and it proved to be successful.
I only had this test because a physio advised me to have the test as she had read that nickel allergies can sometimes cause problems. I do not believe that my surgeon would have asked me about allergies.
 
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Golfer1

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Hello All-
I am now six weeks postop from my right TKR. Like most everyone else, I am having trouble sleeping. I understood from the start that while resting and sleeping my knee needed to be straight. Does anyone have some advice about how long I have to sleep with it straight? I have trouble sleeping on my back and would love to be able to sleep on my side with my knees bent like I did before the surgery.
Thank you! ( I LOVE this website. It has already been so helpful and I intend to follow it and post for quite some time)
 

sistersinhim

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You'll notice that I have merged your two threads together as we prefer that members in recovery only have one thread.

This is for three reasons:
1. if you keep starting new threads, you miss the posts others have left you in the old threads
2. it often ends up that information is unnecessarily repeated
3. it's best if we can keep all your recovery story in one place so it's easily accessed if we need to advise you.
Please keep all your questions and updates on this thread. If you would like a new thread title just post what you would like it to be and we'll change it for you.


There is no need to sleep with your knee completely straight. Having a slight bend is recommended to keep the pain down. You can try sleeping on your side anytime you want to.

Most of time it takes a while before the new knee will allow us to sleep on our sides. I couldn't wait to get back to sleep that way. I started with a pillow between my knees, with my new one under my old one. It's a trial and error thing.
 

Jamie

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When you make the transition from back sleeping to side sleeping, it can be helpful to place two pillows (or a single body pillow) down the length of the bed. Then with your back toward the pillows, lean into them so you are partially on your side and partially on your back and the pillows are supporting your entire torso. Put a pillow between your knees, add some ice if you like, and it should be comfortable for you to sleep. This kind of half-back, half-side position takes the pressure off your spine that many people find difficult to endure when sleeping. It's fine to bend your knees when you're in this position.

People telling you to keep your leg straight comes from the idea that working on your extension is helpful to get back to a normal walking gait. While it is true that some gentle stretches are a good thing in recovery, you don't have to do this all the time to have a good result. After all, you do need to be comfortable to get good rest. As long as you're stretching throughout the day either by walking (trying to take good long strides) and possibly some extension exercises, you should do just fine.
 
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Golfer1

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Thank you, Jamie, for this very useful information. I slept with my knee bent last night and slept a lot better!
 

sistersinhim

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Alright, that's good news! I had to keep my knee a little bent for months.
 

Sara61

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I hated sleeping on my back infact I just could not get a decent nights sleep so very early in my recovery I used a pillow between my knees and slept on my side, making sure as I turned from side to side it was always in place as the knee was too sensitive not to have a pillow there. During the day I just made sure I did a few extra stretch exercises and made a point of walking with larger strides doing heel to toe.
Now I'm the opposite I would love to sleep on my back...but my DH claims I snore :rotfl: so he constantly tells me to roll over:heehee:
 
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Golfer1

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I am now just over seven weeks postop and I am a bit discourage at the moment. I have several questions…
1) I am finding that I can’t stand around in the kitchen for more than 10 minutes or so without my knee feeling like I really need to sit down and elevate. Is this normal at this phase?
2) Prior to my surgery I had a Baker’s cyst behind my knee. During the surgery the surgeon drained it and I thought it was gone for good. However, in the last week or so I am getting swelling behind the knee again. It is very aggravating. Is this something I should worry about? Have I screwed something up?
3) Although I have excellent ROM (115° at six days post-op and 128° at six weeks post-op), it really aggravates my knee (increased swelling) to bend it slightly and put weight on it. Stair stepping is NOT comfortable (even a 3” step or so) and I feel so far away from the ability to walk normally up a set of regular stairs.
4) I am concentrating on a normal heel to toe gait, even though I feel like I have a small water balloon midway between my hip and my ankle. Would some walking around my community be good exercise for me at this point?

I have that tight band feeling that many others have described. I never have pain, just discomfort most of which I believe is probably swelling. I am an overachiever and may be overdoing it with the exercises that physio has prescribed for me. I am having a hard time finding a happy balance.

I am hoping that someone can give me some encouraging advice. Thank you!
 

sistersinhim

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You are doing too much for just 7 weeks out. Did you read the Recovery Articles that Jaycey left for you? In them is the Activity Progression: http://bonesmart.org/forum/threads/activity-progression-for-tkrs.14334/

What you are experiencing is a normal for a knee that is undergoing too much activity. Back off a bit and rest and ice more. You should feel better after a few weeks.
 

Jockette

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It takes quite a few months before standing in one place for any length of time becomes comfortable again.

I haven’t experienced a bakers cyst, so I can’t comment on that.

While the number of your ROM is impressive, your knee/leg still needs more healing time before you actually have the practical function of that number. Going up and down steps foot over foot takes a while, too, and most of us are able to go up that way before we can come down.

Your recovery is coming along fine and you’ll be able to do the things you want, but it will take longer than you want, or were expecting.
 
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Golfer1

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Thank you sistersinhim and Jockette for your responses. You are both very reassuring. I have now realized that I cannot aggressively pursue this recovery. It has been a very humbling experience for me, but also very liberating. I am scaling back on the PT and looking ahead with a much more reasonable mindset.

Again, thank you!
 

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@Golfer1 - your initial post read like my story as well. And important note about staples!! I had never questioned why I had been stitched!

I had always known I had a severe nickel allergy. Itchy, oozing ears from cheap earrings, even had to paint the inside of jeans snaps with nail polish! I never had the test done but did think to ask my OS about it before I had my hips replaced. Fortunately, he was one who understood the potential consequences of implanting prosthetics which contained a lot of nickel. Apparently many surgeons don't think it is an issue, but I have read the stories of many patients who have had implants containing nickel and their disasterous response. My hips are carbon chrome & titanium and my knees are also Smith & Nephews. (He felt any titanium content was too brittle for knees. These contain come nickel but are highly cerametized which apparently creates a barrier between and nickel content and body tissues.)

Funny story (at least in retrospect!): before my knees we did not again discuss my nickel allergy (same OS as for hips) - I assumed it was in my record. Day I was scheduled for bilateral knees I am in pre-op. A nurse comes in to ask if I had any allergies. I said just nickel. Says she - no, I mean food or medicine. She goes on about her business. A bit later, she comes back and says, I think I will give you an allergy bracelet anyway. (Angel #1!) Later the surgical nurse comes in and asks about my bracelet. Nickel. Oh, not a problem - he just needed to know about medicines. Later, she too comes back to ask more about the nickel allergy. (Angel #2!) I get wheeled in, seemingly hours later (I had a nap), and my OS comes in. He has been on the phone all over to locate nickel-free knees. He can get them that day but they will take hours to sterilize. So, we had to reschedule the surgery to the following week.

The nickel allergy had not been preserved in my record, so be sure to mention it any time you are anticipating surgery.
 
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Golfer1

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Hi NightQuilter!
Very informative, albeit sad, story. Sounds like you barely dodged a bullet on that one. If “nickel” hadn’t been emphasize so much, you might have had to have a revision because of your implant. Yikes!

I totally agree that many orthos doing joint replacements don’t place nearly enough emphasis, if any, on the possibility of metal allergies. It should be a standard preop question!
 

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