Patch Testing For Metal Allergy/ Nickel Allergy

Orthopedic Hip / Knee Joint Implant Allergy

An Abstract of our letter to Orthopedic Colleagues is reproduced below. It describes for concerned patients the issue of metal allergy with reference to metal implants, whether hip, knee or other.

Dear Dr. Orthopedic:  Following the publication of a Cleveland Clinic Study on the above subject we have had a number of enquiries from Orthopedic colleagues for Metal Patch Testing, both pre and post metal joint implantation. We are happy to inform you that we can do Metal PATCH TESTING FOR COMMON METALS , BONE CEMENT ACRYLICS AND ANTIBIOTICS used in Orthopedic Implant Procedures, especially hip and knee replacements.

Metal allergy, particularly Nickel allergy and joint replacement has been much in the Orthopedic and lay news recently. Internet has been abuzz with patients blaming pre-existing allergy for all sorts of problems with joint implants such as loosening, infection, non-healing, skin rashes etc. Especially upset are patients who had preoperatively given history of Metal allergy to which the surgeon did not pay any attention. There is at least one lawsuit that can be found on google search, against a cardiologist, blaming restenosis on disregarded preoperative history of Nickel allergy.

Most insurance companies will cover pre or post-operative PATCH TESTING for patients with history suggestive of Contact Dermatitis. History of itchy red rash on contact with a any material, any Recurrent or Chronic persistent itchy skin rash, with or without obvious correlation with allergen exposure, particularly involving hands, feet, face, eyelids, ears and legs is suggestive of  Contact Dermatitis ( Type IV Hypersensitivity). Many Orthopedic advisors now suggest screening all prospective joint implant patients for preexisting hypersensitivity since the rate of post-surgical sensitization is so high.

Current literature suggests that patients with Poorly Functioning Prosthesis should be Patch tested. A strongly positive or a clearly negative report will facilitate your decision whether to re-implant or not, and, most important, what kind of prosthesis to use the second time, so the allergy does not result in the same problem the second time.

IDEALLY, all patients with any history of predisposition to Type IV Allergy or Contact Dermatitis should be PATCH TESTED for metals and acrylics before being scheduled for implant surgery so  non allergic implant alternatives can be chosen if the patient is positive to one of the items to be implanted.    

We will be happy and honored to serve patients who need Patch Testing. Referred patient should not have taken oral steroids or any immunosuppressive for four weeks before the test; and should bring the device manufacturer supplied allergy test kit if any.

Sincerely yours:

If you suspect you are allergic to any metal or acrylic glue, and you are considering surgery where a metal implant may be placed in your body, we can test you for the common metals and glues used in such surgery and if positive your surgeon can usually find an implant that is made with a different material.