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AAOS 2014: Can Allergies Explain Postoperative Joint Replacement Pain?

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The Particulars: Previous research has found that joint replacements can sometimes end in implant failure that is due to factors other than infection or apparent biomechanical issues. It is possible that pain persisting after an apparently successful joint replacement may be due to an allergic reaction to components of the implant, but few studies have explored this possibility.

Data Breakdown: In a small study, researchers assessed patients who experienced persistent pain after undergoing hip, knee, or shoulder replacement surgery and were scheduled for a revision implant. Overall, 58% of patients who were tested for allergies had a positive test relating to their joint replacement. Those with preoperative allergic reactions mostly had reactions to metals, whereas as those who tested for allergies postoperatively mostly reacted to bone cement. Of 15 patients with a revision implant that was chosen based on allergy testing, 14 reported that their condition improved moderately or “a lot.” This compared favorably to the three patients out of 20 whose revision implant was not chosen based on allergy testing. The authors pointed out, however, that their study had a significant loss to follow-up, no placebo-control arm, and a small number of subjects overall.

Take Home Pearls: Choosing revision joint replacement implants based on allergy testing appears to decrease patient complaints of persistent postoperative pain. Additional, larger outcome studies are needed to confirm these results.

3 Comments

  1. I have been diagnosed with an allergy to methyl methacrylate(PMMA) used as bone cement, also cobalt and nickel tested twice,once at Mass General and once at Brigham &Women’s both by patch & blood tests. I have had 3 knee implants fail completely because of this problem. I am now trying to find a doctor that will do a cement less revision in the New England area. Implants lasted 6 years for the first, 2 years for the second and 3 months for the last one, #3 was mixed with lots of antibiotic and bone cement. Anyone know of a doctor that will do a 4th revision. Never had any infection problems and minimal bone loss after each revision.

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  2. need complete knee replacement and have allergies to cements and nickel. how can I be tested for cements?

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    • Denise Middleton
      I was tested at both Mass General & Brigham & Women’s in Boston. Testing was done by patch testing By Dr Pamela Scheinman at Brigham and Dr Peter Schalock at Mass General. Both were done using controlled patch tests that were in place for 2 days then removed and analyzed by the doc tors. I have a extreme reaction to the bone cement methyl methacrylate along with strong reaction to cobalt and chromium. I am trying to find a doctor in New England area without any luck. I found a doctor at the Anderson Clinic in Alexandria Va. but the prosthesis manufacturer Zimmer and Biomet have merged together and the doctors haven’t been able to get the manufacturer to build a prosthesis after sending them a 3D scan that was done back in September of 2015. I finally had the doctor cancel the cement less implant after waiting for 4 months. The only other doctor that is doing cement less implants is at UCLA medical center Harbor Branch in LA. Haven’t contacted him yet. Went to my ortho in Boston and he wants me to have a fusion of the knee which will not allow me to bend my knee at all and it’s a 2 stage operation, removal of the old 3rd revision, then inserting metal rods and cage around my knee area for al least 6 months of my life. Not going that way at this time. Good luck with your search for a doctor that will do a patch test in your area.

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