We obtained written informed consent from the patient for the publication of this case report and accompanying images. does it exst? Nam D, Li K, Riegler V, Barrack RL. The striking features of titanium include its stability with increased resistance to corrosion and its biocompatibility to diverse materials [3]. These degradation products of the implant may cause increased metal hypersensitivity and implant failure. 1975 Nov 15;4(5993):376-8 does it exst? Symptoms of a Reaction Unfortunately, the symptoms of metal implant sensitivity and allergy are not well defined. 2023 Dr. Stefano Sinicropi The information contained on this site is intended to provide only general education about spine surgery and conditions. Our website is not intended to be a substitute for professional medical advice, diagnosis, or treatment. These cookies will be stored in your browser only with your consent. Your email address will not be published. Metal hypersensitivity reactions to orthopedic implants. The titanium screws used in the orthopedic surgery that he underwent were removed 1 year later, but the eczema remained. To complicate things, patients may also develop delayed-type hypersensitivity reactions to metals (ie, in-stent restenosis, prosthesis loosening, inflammation, pain, or allergic contact dermatitis) following the insertion of intravascular stents, dental implants, cardiac pacemakers, or implanted gynecologic devices. Okamura et al. It may be necessary to remove the spinal hardware to avoid any further complications. This site needs JavaScript to work properly. However, all the symptoms were resolved after the removal of the offending agent [57]. Immune response differences in degradable and non-degradable alloy implants. Knee replacement failure due to metal allergy or sensitivity is very rare but possible. 13/17 underwent revisions to conventional THR; 8/13 with improved symptoms; 4/13 with Some orthopedic implants contain small amounts of nickel, and there's been a concern that this may be an issue for nickel-sensitive people. reports an 86-year-old woman who presented three years to postlaparoscopic cholecystectomy with subdiaphragmatic abscess due to titanium surgical clips used during the procedure [4]. doi: 10.7759/cureus.26167. An official website of the United States government. Out of these, the cookies that are categorized as necessary are stored on your browser as they are essential for the working of basic functionalities of the website. The base metals are found in the highest quantities, but smaller amounts of other metals, such as nickel and aluminum, are often used. Health care providers have been known to rely more on staples in performing surgeries. The catheter was removed surgically which resolved the patients RLQ abdominal pain and accompanying symptoms. Summary. [5] Independent of the primary cause of metal sensitization, the insertion of metallic implants may result in eczematous eruptions on the skin overlying the implant or in device failure caused by delayed-type hypersensitivity (DTH) (eg, chronic inflammation, pain, loosening of joint prostheses, or restenosis of cardiac stents). The management of any metal allergy including titanium involves removing specific offending agents and avoiding potential triggers to hypersensitivity reactions. An allergic contact dermatitis to stainless steel implants is an infrequent and poorly understood occurrence. The patient tolerated the procedure well with no postoperative complications. Allergic reactions occur when a substance triggers an immune response. 55435 One of the rare complications from the use of staples in surgery is an allergic reaction, mainly because of the components or materials present in the staple. [6] This review aims to update the reader on the general aspects of this complex topic and to briefly discuss future challenges. DHT is typically diagnosed by excluding all other causes of post-operative knee pain, such as: It is only after these causes are excluded that metal sensitivity is explored. We describe a case of chronic abdominal pain, which is potentially complicated by retained titanium surgical clips and subsequently a retained portion of a pigtail catheter. Shortness of breath. 1, pp. The case also unfolds rare differential diagnoses to keep in mind when encountering a patient with abdominal pain and associated nonspecific symptoms. Late onset infection can occur in some cases where you have some focus of infection causing bacteremia,and the sign symptoms include, redness. Finally, the blood test could be effectively used to diagnose type IV hypersensitivity allergic reactions, including contact dermatitis or eczema reported by few studies on titanium allergy [12]. 1 Patients with MHS reactions to implants typically have prolonged eczematous dermatitis.8 Although the majority of MHS reactions are localized, more widespread inflammation has been reported. M. Tu and Y. Wu, Multiple allergies to metal alloys, Dermatologica Sinica, vol. Please enter a Recipient Address and/or check the Send me a copy checkbox. Sun et al., Suspected allergy to titanium after anterior cervical discectomy and fusion using a Zero-P device: a case report, British Journal of Neurosurgery, pp. Metal hypersensitivity can begin at any time, even if you have never had a reaction before. Chronic eczema beginning weeks or months after the implant, 2. Itchy eyes, nose or roof of mouth. Spinal hardware is used in a number of minimally invasive spine surgeries. -, Lancet. Revision to a ceramic-on-ceramic THR led to symptom resolution. Further Reading eCollection 2022 Jun. The most important allergens in this category include nickel, cobalt, chromium, and bone cement. Accessibility and transmitted securely. Common symptoms of MHS reactions include localized pain, swelling, redness, warmth, loosening, draining, itching/burning, and implant instability. 1, pp. Implants made from titanium, ceramic, and coated parts are considered safe for people with metal allergies and unlikely to cause a reaction. 1. Keywords: Spinal hardware (screws, plates, rods, etc.) But opting out of some of these cookies may affect your browsing experience. Published by Elsevier Ltd.. All rights reserved. 97100, 2017. Metals corrode in biologic systems, allowing for hapten formation. Moreover, metal allergy screening should be considered for patients with past hypersensitivity reactions before any surgery. Restenosis occurred predominantly in patients with negative patch-test reaction to nickel. -, Br Med J. The risk of surgical revision was not increased in patients with metal allergies, and the risk of metal allergy was not increased in patients who were operated on, in comparison with controls. Allergic reactions to staples, clips, and other metallic implants may be rare, but it can have adverse health effects on a patient. The CT scan showing a portion of the pigtail catheter lodged within the cecum in a coronal view (a), sagittal view (b), and axial view (c). Juliana L. Basko-Plluska; Jacob P. Thyssen; Peter C. Schalock. P. H. Wu, J. H. Chen, and K. E. Chu, Successful endoscopic management of double iatrogenic perforations induced by endoscopic retrograde cholangiopancreatography and computed tomography-guided colon drainage, Case Reports in Gastroenterology, vol. Every surgical procedure comes with a number of risks, and a surgery to close a wound with surgical staples is no exception. 7, no. Cutaneous reactions to metal implants, orthopedic or otherwise, are well documented in the literature. doi:10.1007/s11420-016-9514-8. Contact Dermatitis. Our case is about a 28-year-old female presenting with a spectrum of abdominal symptoms with a complicated medical history. PMC sores and swelling in the soft tissues of the mouth. Prospective: 171 total stents; in-stent restenosis in 100% of patients with positive patch-test result but in only 57% of patients with negative patchtest results; no control group; only significant differences were for nickel and molybdenum. Revision to cementless total hip with ceramic-onceramic bearing led to symptom resolution. 4143, 2011. CT scan was promptly ordered to rule out the severe complication of toxic megacolon as a result of C. difficile infection. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. Healthcare providers now believe that the term, "iodine allergy" should no longer be used because it is inaccurate. If a glass of milk or slice of pizza causes swollen lips, hives, or other symptoms, you may have an allergy to casein, a protein in milk. Erica is our staff writer and oversees the overall content on Drugwatcher. What are the symptoms of an allergic reaction to titanium? Fage SW, Muris J, Jakobsen SS, Thyssen JP. Food and Drug Administration. Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery. Middleton S, Toms A. World J Orthop. Although removal of offending. Clinically, diagnosis of metal implant allergy is a process of excluding differential diagnoses, specifically infection. Watery, runny eyes. The patient had delayed hypersensitivity reaction to nickel in the past with erythematous rash formation and severe itching. The patient has been recommended to do a close follow-up for a few months to monitor her progress. The skin patch test has not yet been developed as the valid standardized test for titanium allergy. However, we suggest that pre-implant patients should be asked about a history of hypersensitivity reactions to metals, and patch testing should be recommended to patients who have experienced such reactions. AAAAI 2009: Half of Physicians Fail to Prescribe EpiPen for Patients With History of Anaphylaxis, Contact Allergens Lurk in Diabetes Devices, New Guidance on Alpha-Gal Syndromes GI Implications: What to Know. Severe skin rashes. Six metal surgical clips removed from the RUQ via fluoroscopic guidance. None had issues despite confirmed allergy to one of the metals in their device (6-year follow-up). The Improvement of Nonspecific Chronic Symptoms Post-Gallbladder Clip Removal. The woman also had a cholecystectomy back in 2007, and thats when she began experiencing symptoms including joint pain and tenderness, cramps, dry skin and hair, racing heart, hand tremors, and high blood pressure, among many others. The most common symptoms of hypersensitivity to metals include: hives blistering of the skin rash swelling reddening of skin depression joint pain chronic fatigue fibromyalgia (widespread pain without known cause) chronic inflammation cognitive impairment Read our. Popiolek I, Blasiak M, Kozak A, Pietak E, Bulanda M, Porebski G. Diagnostics (Basel). The Opioid Epidemic. The patient contacted our department the next morning, and the case and CT findings were reviewed. Kohal RJ, Burkhardt F, Chevalier J, Patzelt SBM, Butz F. J Funct Biomater. 2023 Mar 20;16(6):2463. doi: 10.3390/ma16062463. However, it indeed seems titanium allergy had a significant role in her abdominal discomfort owing to her positive allergy test results further proving titanium hypersensitivity in this patient. Throughout this article, we do the same. The signs and symptoms of a late infection present a challenge in the setting of a bioabsorbable interference screw. Moreover, titanium has been described to activate macrophages through phagocytosis to cause the release of pro- and anti-inflammatory cytokines [9]. It is based on symptoms that are associated with allergies in the form of rashes, urticarial, pruritus, swelling in the region of the orofacial, erythema of facial as well as oral, eczematous lesions in the area of the cheeks. 2022 Dec 19;24:153-170. doi: 10.1016/j.bioactmat.2022.12.012. This resulted in approximately 75lbs. By clicking the button you accept our disclaimer and privacy policy. Regardless of all these factors, surgeons and clinicians must have a high clinical suspicion of RFB and appropriate diagnostic imaging for diagnosis and removal of the RFB. 4, pp. So a person who has already had spinal hardware put in place can potentially develop an allergy to it years down the line. This requires immediate attention and an X-ray for further investigation. Also, more complex immune reactions may develop around the implants,. 2022 Oct 24;14(10):e30625. When they do occur, however, the associated pain, swelling, inflammation, and decreased range of motion can significantly impair the implant function. Additionally, standard surgical instruments such as electrodes, drains/catheters, retractors, or clamps can be left unrecognized after operations, especially in the abdominal space [13]. However, several studies have reported cases of metal allergy caused by titanium-containing materials. After the diagnosis of RFB, the preferred approach is to remove the RFB laparoscopically [13].
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