ArticleThe Journal of bone and joint surgery. American volume2017
Females with Unexplained Joint Pain Following Total Joint Arthroplasty Exhibit a Higher Rate and Severity of Hypersensitivity to Implant Metals Compared with Males: Implications of Sex-Based Bioreactivity Differences.
Article in The Journal of bone and joint surgery. American volume, 2017. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers.
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Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.
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Who cites it
24 citing papers in PubMed, 56 citations in OpenAlex.
- Course of pain after total hip arthroplasty within a standardized pain management concept: a prospective study examining influence, correlation, and outcome of postoperative pain on 103 consecutive patients.Archives of orthopaedic and trauma surgery · 2018Trial
- Outcomes of Metal Hypersensitivity in Knee Arthroplasty: A Systematic Review of the Literature.Arthroplasty today · 2026Article
- Toward Sex-Specific Biomaterials Innovation: A Perspective.ACS biomaterials science & engineering · 2025Review
- Long-term outcomes of small head metal-on-metal compared to ceramic-on-polyethylene primary total hip arthroplasty: a registry-based cohort study.International orthopaedics · 2025Article
- Sex Disparities in Opioid Prescription and Administration on a Hospital Medicine Service.Journal of general internal medicine · 2024Article
- Sex and Gender in Orthopaedic Research: How Do We Continue to Move the Needle?The Journal of bone and joint surgery. American volume · 2024Article
- Over a decade of experience in total knee arthroplasty with a multiradius design and fixed bearing at a single centre: Data from the Catalan Arthroplasty Registry.Journal of experimental orthopaedics · 2024Article
- Hypersensitivity to metals in metal-on-metal hip arthroplasty: a prospective study of one hundred and thirty five lymphocyte transformation tests.International orthopaedics · 2024Article
- Establishing clinically meaningful ranges of metal hypersensitivity in orthopaedic patients using COVID-19 vaccine-induced adaptive immune responses from fully vaccinated adults.Journal of orthopaedics · 2024Article
- Cultural Competence and the Postoperative Experience: Pain Control and Rehabilitation.Arthroscopy, sports medicine, and rehabilitation · 2023Article
- Implementing fast-track in total hip arthroplasty: rapid mobilization with low need for pain medication and low pain values : Retrospective analysis of 102 consecutive patients.Zeitschrift fur Rheumatologie · 2022Article
- Evaluation of local tissue peri-implant reaction in total knee arthroplasty failure cases.Therapeutic advances in musculoskeletal disease · 2022Article
- Metal allergy in primary and revision total knee arthroplasty : a scoping review and evidence-based practical approach.Bone & joint open · 2021Article
- Sex-Specific Response to Combinations of Shear Stress and Substrate Stiffness by Endothelial Cells In Vitro.Advanced healthcare materials · 2021Article
- Suspected Metal Allergy and Femoral Loosening After Total Knee Arthroplasty: A Diagnostic Dilemma.Arthroplasty today · 2021Article
- Metal-induced delayed type hypersensitivity responses potentiate particle induced osteolysis in a sex and age dependent manner.PloS one · 2021Article
- Mechanically Assisted Crevice Corrosion in a Metal-on-Polyethylene Total Hip Presenting With Lower Extremity Vascular Compromise.Arthroplasty today · 2020Article
- Do Battlefield Injury-acquired Indwelling Metal Fragments Induce Metal Immunogenicity?Clinical orthopaedics and related research · 2020Article
- Improved outcomes in patients with positive metal sensitivity following revision total knee arthroplasty.Journal of orthopaedic surgery and research · 2019Article
- Modifiable and Nonmodifiable Predictive Factors Associated with the Outcomes of Total Knee Arthroplasty.Joints · 2019Review
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Authors and funding
5 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundRecent studies indicate that females demonstrate an increased risk of experiencing adverse local tissue reactions, aseptic loosening, and revision after primary metal-on-metal hip resurfacing arthroplasty compared with males; the underlying biological mechanisms responsible for sex discrepancies in implant failure remain unclear. In addition to anatomical and biomechanical sex differences, there may be inherent immunological disparities that predispose females to more aggressive adaptive immune reactivity to implant debris, i.e., metal sensitivity.
methodsIn this retrospective study, we analyzed sex-associated rates and levels of metal sensitization in 1,038 male and 1,575 female subjects with idiopathic joint pain following total joint arthroplasty (TJA) who were referred for in vitro metal-sensitivity testing.
resultsFemales demonstrated a significantly higher rate and severity of metal sensitization compared with males. The median lymphocyte stimulation index (SI) among males was 2.8 (mean, 5.4; 95% confidence interval [CI], 4.9 to 6.0) compared with 3.5 (mean, 8.2; 95% CI, 7.4 to 9.0) among females (p < 0.05). Forty-nine percent of females had an SI of ≥4 (reactive) compared with 38% of males, and the implant-related level of pain was also significantly (p < 0.0001) higher among females (mean, 6.8; 95% CI, 6.6 to 6.9) compared with males (mean, 6.1; 95% CI, 6.0 to 6.3).
conclusionsIn a select group of patients who had joint pain following TJA and no evidence of infection and who were referred for metal-sensitivity testing, females exhibited a higher level of pain and demonstrated a higher rate and severity (as measured by lymphocyte SI) of metal sensitization compared with males. LEVEL OF EVIDENCE: Prognostic Level III. See Instructions for Authors for a complete description of levels of evidence.
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