TKR Nickel Allergy

sgh2700

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I had a Conformis Custom Knee replacement in July 2021. My recovery was normal, I think, except the fact that I had 2 small scabs on my incision that never quite healed. They "almost" healed, then got worse, then other parts of the incision started to open again and I had a horrible rash all over my entire body...especially on my lips--this was 3 months PO . I saw a dermatologist who gave me prednisone, antibiotics and an antiviral. He also set up allergy testing--skin patch. Scab healed and all was well...until it wasn't. Scabs reappeared and I got the rash back. Finally got the results of the allergy testing and it turns out I am allergic to nickel...which my implant contains a very small amount of. I have my 2nd knee scheduled in 1.5 months, so I am sure that is going to be quickly canceled--just got my results yesterday. I guess what is puzzling to me right now is the fact that I have absolutely no pain in my replaced knee--I just got home from a 1 hour walk. From other posts I have read re: metal allergies it seems like the most common symptom/issue is pain in the joint. Is there anyone out there with a similar issue? Dermatologist says best case scenario is that I occasionally have to deal with a rash. I can live with that, although I am not certain that will be the case.
 
Hi and Welcome!

I‘m sorry to hear you are dealing with an allergy. I would suggest you also get the blood allergy test. Your insurance might not cover it, but it’s a worthwhile test to get, and is more accurate in a joint replacement situation.

For anyone who would like to get a full metal allergy test prior to any joint replacement surgery, you can get the test done in the USA by ordering the test kit from https://www.orthopedicanalysis.com/testing/order-testing-panel . You want the Orthopedic Panel Test 2. Once you get the test kit, your GP (or any lab) can do the blood draw and send it in for testing. You will have to have a doctor's order for the lab to run it.
 
Jockette is right. You need an in-depth allergy test, not just the skin test. You might find out that you are much more allergic than the first finding. One thing I found out about the test after buying it is that you have to have a doctor's order for them to process it. Luckily, they took the test back and refunded the cost.

Something is causing your reaction and you need to find out what it is. This blood test will be one thing that can be checked off.
 
A patch test (5-day skin test; not a prick test) was helpful in my case to identify type IV allergies. Nickel is one of the most common allergies of this kind. @sgh2700 I have a number of type IV allergies identified via patch testing. An acrylate allergy is the reason I have cementless implants. If you like I can direct you to a (closed) FB group dedicated to managing this kind of allergy. I am sure you will find people there who can share their experiences with allergic reaction to nickel in their medical or dental implants.

 
I have not been tested for a nickel allergy but have found that under certain circumstances, my ear piercings can get irritated and will weap. If I switch to nickel free earrings, it will clear up. I mentioned it to my os and I was given a nickel free implant. I mention this to point out the value of bringing up concerns even if they seem minor.
 
A patch test (5-day skin test; not a prick test) was helpful in my case to identify type IV allergies. Nickel is one of the most common allergies of this kind. @sgh2700 I have a number of type IV allergies identified via patch testing. An acrylate allergy is the reason I have cementless implants. If you like I can direct you to a (closed) FB group dedicated to managing this kind of allergy. I am sure you will find people there who can share their experiences with allergic reaction to nickel in their medical or dental implants.

Thanks. I would love to have your info re: a Facebook group. From my patch test they found I was not only allergic to nickel, but also the glue and mesh that was used on my knee. That caused a rash that was not really that bad, but irritating.
 
Thanks. I would love to have your info re: a Facebook group. From my patch test they found I was not only allergic to nickel, but also the glue and mesh that was used on my knee. That caused a rash that was not really that bad, but irritating.
Of course! The group is named Eczema, Contact Dermatitis, and Patch Testing Alliance. You will need to request to join. There are some related groups specific to nickel allergy that mods/members will probably recommend to you. Since nickel isn’t one of mine I’ll leave the recommending to them.
 
my ear piercings can get irritated and will weap. If I switch to nickel free earrings, it will clear up.

This makes me quite nervous. I have this same issue with earrings. I didn't realize this is something that I should be aware of. I hope I continue to not have issues with the implant.
 
I discovered I had a nickel allergy when the dermatitis around where my bra hooks sit got beyond a joke. I have quite severe discoid eczema and thought it was that. My dermatologist proved otherwise.
It's a nickel allergy. I just added it to the list of allergens I react to.
 
Do all implants contain nickel?
Not all implants contain nickel, but it seems we only get the ones that don’t, unless a allergy is known ahead of time. Try not to worry about it. While metal allergies do happen, its not that often, in the grand theme of things.
 
Hello, I agree with getting the blood test. I did not develop pain in my knee for sometime after the RTKR. I believe it was around 8 months later that I started having some pain. OS did a bunch of tests, one of which was the blood allergy test after the skin test, as I told him I have issues with regular earrings etc. It came up that I was allergic to nickel. My components had started to loosen so I had a revision to do another TKR. After many more revisions, my current revision specialist pointed out that the left TKR I had in 2008 is doing fine so can’t be nickel allergy. He revised my right with standard components in early 2020. I’m still having issues even after another revision for stretched ligaments, but no idea what it might be. Maybe it is nickel allergy just on right? No idea but thanks for reminding me about the potential nickel allergy! I did not have any of the skin or scar issues you have, only the joint. Please let me know how it goes and I will do the same! Good luck
 
Hello, I agree with getting the blood test. I did not develop pain in my knee for sometime after the RTKR. I believe it was around 8 months later that I started having some pain. OS did a bunch of tests, one of which was the blood allergy test after the skin test, as I told him I have issues with regular earrings etc. It came up that I was allergic to nickel. My components had started to loosen so I had a revision to do another TKR. After many more revisions, my current revision specialist pointed out that the left TKR I had in 2008 is doing fine so can’t be nickel allergy. He revised my right with standard components in early 2020. I’m still having issues even after another revision for stretched ligaments, but no idea what it might be. Maybe it is nickel allergy just on right? No idea but thanks for reminding me about the potential nickel allergy! I did not have any of the skin or scar issues you have, only the joint. Please let me know how it goes and I will do the same! Good luck

Thanks for sharing your story. My dermatologist did not recommend taking our the knee at this time due to the fact that my knee does not hurt and my rash is improving. She also is not certain my symptoms are from the nickel in my knee. My implant has .5-1 percent nickel. I have done a little more investigation on my own and discovered that my hip replacement implant, which I have had for 14 years, also has .5 percent nickel. I have not met with my surgeon since her findings, but maybe he will do a bone scan, or maybe we will just 'wait and see" I am sure of one thing and that is that he will not be replacing my other knee with the same implant. I have a strong cortisone ointment that I am putting on my incision and it is healing. Dermatologist notes said something about "delayed wound healing." I read about that and I really don't fit the kind of person who usually would have something like that--I usually am what I call a "quick healer." Yes, I definitely will let you know how this turns out and hope your situation is also improving.
 
Thanks for the update, keep digging, the more information the better we are at making decisions. Really curious to hear how it goes. Good luck! I went for a checkup and seems my ligaments are stretching more…so more surgery or a brace forever. But pain is manageable. Waiting until I have a year after my last surgery, so until May to decide what to do next.
 
I know I'm late to the party - but the same thing happened to me - except I got the testing first (patch and then MELISA). Conclusion - my hip replacement is permanently "on-hold" The doctor that did the tests said you could have a systemic reaction - which means it could pop up someplace else. Because of the tests, I am now getting a lot of my dental work replaced and reactions that I attributed to something else, were actually the dental work.

I can't believe the manufacturers have not come up with a solution for people with allergies. Nickel is very very common in women and when I was looking for a surgeon, not once was I asked if I had a metal allergy.
 
They do make a metal free hip implant. This Doctor is in Seattle Washington and is one of the most highly respected hip surgeons in the world.



Golfer67
 
Hello,
Saw this thread and thought I'd add my 2 cents for people searching for metal allergy problems. I just got the Orthopedic Analysis metal sensitivity blood tests results back yesterday and I am "highly sensitive" to Nickel. My symptoms were a small skin irritation within the first month after the surgery, but that went away. Ever since the surgery it was always painful to put full weight on that knee and over time my range of motion was terrible (15-85) and never improved. Anyone else with symptoms like these, I recommend getting a metal sensitivity test to see if metal in the implant is the problem. There's a wide range of symptoms and they are not the same for everyone.

These tests should be standard and covered by insurance before getting such a huge piece of hardware put in your body permanently.
 

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