TY - JOUR
T1 - Suspected Metal Allergy and Femoral Loosening After Total Knee Arthroplasty
T2 - A Diagnostic Dilemma
AU - Lieberman, Elizabeth G.
AU - Barrack, Robert L.
AU - Schmalzried, Thomas P.
N1 - Publisher Copyright:
© 2020 The Authors
PY - 2021/2
Y1 - 2021/2
N2 - Metal sensitivity is increasingly prevalent and is associated with negative outcomes after total knee arthroplasty (TKA). Currently, there is no consensus on diagnostic criteria for TKA failure from immune reaction. We present a patient who had pain and aseptic effusion 2 years after TKA. Radiographs were concerning femoral loosening. Lymphocyte transformation testing showed nickel sensitivity. During revision surgery, the femoral component was loose. The histologic aseptic lymphocyte-dominated vasculitis-associated lesion score was 4 with elevated CD4+ lymphocytes, consistent with sensitization. Nickel-free revision implants were used. One year after surgery, the patient is symptom-free. This case has features suggestive of an immune reaction, with femoral loosening, and is illustrative of the diagnostic dilemma. Using a hypoallergenic knee eliminates future concern for nickel sensitivity.
AB - Metal sensitivity is increasingly prevalent and is associated with negative outcomes after total knee arthroplasty (TKA). Currently, there is no consensus on diagnostic criteria for TKA failure from immune reaction. We present a patient who had pain and aseptic effusion 2 years after TKA. Radiographs were concerning femoral loosening. Lymphocyte transformation testing showed nickel sensitivity. During revision surgery, the femoral component was loose. The histologic aseptic lymphocyte-dominated vasculitis-associated lesion score was 4 with elevated CD4+ lymphocytes, consistent with sensitization. Nickel-free revision implants were used. One year after surgery, the patient is symptom-free. This case has features suggestive of an immune reaction, with femoral loosening, and is illustrative of the diagnostic dilemma. Using a hypoallergenic knee eliminates future concern for nickel sensitivity.
KW - Metal allergy
KW - Total knee arthroplasty
KW - Total knee replacement
UR - http://www.scopus.com/inward/record.url?scp=85099356757&partnerID=8YFLogxK
U2 - 10.1016/j.artd.2020.11.002
DO - 10.1016/j.artd.2020.11.002
M3 - Article
C2 - 33521207
AN - SCOPUS:85099356757
SN - 2352-3441
VL - 7
SP - 114
EP - 119
JO - Arthroplasty Today
JF - Arthroplasty Today
ER -