Compliant Intramedullary Stems for Joint Reconstruction.

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Abstract

[Indexed for MEDLINE] 4. J Am Acad Orthop Surg. 2017 Oct;25(10):693-702. doi: 10.5435/JAAOS-D-16-00007. Allergic or Hypersensitivity Reactions to Orthopaedic Implants. Roberts TT(1), Haines CM, Uhl RL. Author information: (1)From the Neurological Institute, Cleveland Clinic, Cleveland, OH (Dr. Roberts and Dr. Haines) and the Division of Orthopaedic Surgery, Albany Medical Center, Albany, NY (Dr. Uhl). Allergic or hypersensitivity reactions to orthopaedic implants can pose diagnostic and therapeutic challenges. Although 10% to 15% of the population exhibits cutaneous sensitivity to metals, deep-tissue reactions to metal implants are comparatively rare. Nevertheless, the link between cutaneous sensitivity and clinically relevant deep-tissue reactions is unclear. Most reactions to orthopaedic devices are type IV, or delayed-type hypersensitivity reactions. The most commonly implicated allergens are nickel, cobalt, and chromium; however, reactions to nonmetal compounds, such as polymethyl methacrylate, antibiotic spacers, and suture materials, have also been reported. Symptoms of hypersensitivity to implants are nonspecific and include pain, swelling, stiffness, and localized skin reactions. Following arthroplasty, internal fixation, or implantation of similarly allergenic devices, the persistence or early reappearance of inflammatory symptoms should raise suspicions for hypersensitivity. However, hypersensitivity is a diagnosis of exclusion. Infection, as well as aseptic loosening, particulate synovitis, instability, and other causes of failure must first be eliminated. DOI: 10.5435/JAAOS-D-16-00007