ArticleJournal of orthopaedic surgery and research2019
Improved outcomes in patients with positive metal sensitivity following revision total knee arthroplasty.
Article in Journal of orthopaedic surgery and research, 2019. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 18 papers, 1 of them a synthesis that pooled it.
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The trial behind it
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
18 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Metal sensitivity in total joint arthroplasty: None of the current diagnostic tests are reliable, sensitive and specific enough to guide treatment decisions!Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA · 2025Pooled it
- Outcomes of Metal Hypersensitivity in Knee Arthroplasty: A Systematic Review of the Literature.Arthroplasty today · 2026Article
- Mid-Term Results of a Cemented Titanium-Niobium Nitride-Coated Mobile Knee in Primary Total Knee Arthroplasty.Journal of clinical medicine · 2025Article
- Updates in Metal Allergy: A Review of New Pathways of Sensitization, Exposure, and Treatment.Current allergy and asthma reports · 2025Review
- Evaluation of Functional Outcomes, Survivorship and Complications of Hypoallergenic Fixed-Bearing Medial and Lateral Unicompartmental Knee Arthroplasty: A Minimum 2-Year Follow-Up.Journal of clinical medicine · 2025Article
- Metal Hypersensitivity in Patients With Failure of Joint Prosthesis Treatment.Journal of immunology research · 2025Article
- Long-Term Stability in Temporomandibular Joint Replacement: A Review of Related Variables.Dentistry journal · 2024Review
- Hypoallergenic Knee Implant Usage and Clinical Outcomes: Are They Safe and Effective?Arthroplasty today · 2024Article
- First Italian Experience with the Oxinium Metal-Backed Fixed-Bearing Medial Journey II Unicompartmental Knee System: Promising Short-Term Outcomes of 145 Cases.Journal of clinical medicine · 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
- Additively Manufactured 17-4 PH Stainless Steels for Fracture Management Devices.Virtual and physical prototyping · 2024Article
- Similar clinical and radiographic outcomes after two different hypoallergenic medial unicompartmental knee in patients with metal allergy.European journal of orthopaedic surgery & traumatology : orthopedie traumatologie · 2023Article
- Metal Allergy: State-of-the-Art Mechanisms, Biomarkers, Hypersensitivity to Implants.Journal of clinical medicine · 2022Review
- Metal allergy in primary and revision total knee arthroplasty : a scoping review and evidence-based practical approach.Bone & joint open · 2021Article
- No Clinical or Radiographic Differences Between Cemented Cobalt-Chromium and Titanium-Niobium Nitride Mobile-Bearing Unicompartmental Knee Arthroplasty.Indian journal of orthopaedics · 2021Article
- Bone Cement Hypersensitivity in Patients With a Painful Total Knee Arthroplasty: A Case Series of Revision Using Custom Cementless Implants.Arthroplasty today · 2021Article
- Self-reported metal hypersensitivity in patients undergoing unicondylar knee arthroplasty.Journal of clinical orthopaedics and trauma · 2021Article
- Osteoimmunology: A Current Update of the Interplay Between Bone and the Immune System.Frontiers in immunology · 2020Review
Corrections and comments
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Authors and funding
5 authors.
Funding
Abstract
backgroundMetal sensitivity as a cause for painful joint replacement has become increasingly prevalent; however, there is a lack of reported clinical outcome data from total knee arthroplasty patients with metal allergies. The purpose of this study was to determine whether patients presenting with a painful total knee arthroplasty with a positive metal sensitivity have improved outcomes following revision to a hypoallergenic implant.
methodsA retrospective review was conducted for patients that underwent a revision total knee arthroplasty after metal sensitivity testing over a 3-year period from January 1, 2015, to December 31, 2017. Based on the results of sensitivity testing, patients underwent revision total knee arthroplasty to a hypoallergenic component or a standard component. Following revision, patients returned to the clinic at an interval of 6 weeks, 5 months, and 12 months for functional, pain, and satisfaction assessment. Outcomes were compared within and between sensitivity groups.
resultsOf the included patients, 78.3% (39/46) were positive for metal sensitivity. The most common metal sensitivity was to nickel (79.5%, 32/39). Both non-reactive and reactive patients significantly improved in range of motion after revision arthroplasty. The reactive group saw a 37.8% decrease in pain at 6 weeks post-revision (p < 0.001) Whereas, the non-reactive group only saw a moderate, non-significant improvement in pain reduction at 6 weeks post-revision (27.0%; p = 0.29). Frequency of pain experienced did not vary significantly between groups. Maximum metal lymphocyte transformation test (LTT) sensitivity score did not correlate with pain level at the time of revision (R
conclusionsPatients presenting with a painful knee arthroplasty and positive metal LTT have improved pain scores, walking function, and range of motion following revision to a hypoallergenic component. This study also provides a treatment algorithm for patients presenting with a painful knee replacement, in order to provide effective and timely diagnosis and management.
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