Improved outcomes in patients with positive metal sensitivity following revision total knee arthroplasty
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(2019) 14:182
RESEARCH ARTICLE
Open Access
Improved outcomes in patients with positive metal sensitivity following revision total knee arthroplasty Robert L. Zondervan1*† , Jonathan J. Vaux2†, Michael J. Blackmer2, Brett G. Brazier1 and Charles J. Taunt Jr2
Abstract Background: Metal sensitivity as a cause for painful joint replacement has become increasingly prevalent; however, there is a lack of reported clinical outcome data from total knee arthroplasty patients with metal allergies. The purpose of this study was to determine whether patients presenting with a painful total knee arthroplasty with a positive metal sensitivity have improved outcomes following revision to a hypoallergenic implant. Methods: A retrospective review was conducted for patients that underwent a revision total knee arthroplasty after metal sensitivity testing over a 3-year period from January 1, 2015, to December 31, 2017. Based on the results of sensitivity testing, patients underwent revision total knee arthroplasty to a hypoallergenic component or a standard component. Following revision, patients returned to the clinic at an interval of 6 weeks, 5 months, and 12 months for functional, pain, and satisfaction assessment. Outcomes were compared within and between sensitivity groups. Results: Of the included patients, 78.3% (39/46) were positive for metal sensitivity. The most common metal sensitivity was to nickel (79.5%, 32/39). Both non-reactive and reactive patients significantly improved in range of motion after revision arthroplasty. The reactive group saw a 37.8% decrease in pain at 6 weeks post-revision (p < 0.001) Whereas, the non-reactive group only saw a moderate, non-significant improvement in pain reduction at 6 weeks post-revision (27.0%; p = 0.29). Frequency of pain experienced did not vary significantly between groups. Maximum metal lymphocyte transformation test (LTT) sensitivity score did not correlate with pain level at the time of revision (R2 = 0.02, p = 0.38) or percent improvement after revision (R2 = 0.001, p = 0.81). Overall, all patients reported being very satisfied after revision total knee arthroplasty; there was no difference between positive and negative sensitivity groups (W = 62, p = 0.89). Conclusions: Patients presenting with a painful knee arthroplasty and positive metal LTT have improved pain scores, walking function, and range of motion following revision to a hypoallergenic component. This study also provides a treatment algorithm for patients presenting with a painful knee replacement, in order to provide effective and timely diagnosis and management. Keywords: Metal allergy, Metal sensitivity, Arthroplasty, Orthopedics, Knee, Hip, Lymphocyte transformation test, LTT
* Correspondence: [email protected] † Robert L. Zondervan and Jonathan J. Vaux contributed equally to this work. 1 Michigan State University College of Osteopathic Medicine, 965 Wilson Rd, East Lansing, MI 48824, USA Full list of author information is available at the end of the article © The Author(s). 2019 Open Access This article is d
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