ReviewJournal of clinical orthopaedics and trauma2020
Nickel allergy to orthopaedic implants: A review and case series.
Review in Journal of clinical orthopaedics and trauma, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 24 papers, 1 of them a synthesis that pooled it.
What it found
Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.
The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.
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.
Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.
Who cites it
24 citing papers in PubMed, 1 synthesis or guideline pooled it, 41 citations in OpenAlex.
- 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
- Transjugular Leadless Pacemaker in a Preschool Child With Nickel-Titanium Allergy.JACC. Case reports · 2026Article
- A comprehensive review of biomechanical factors influencing pedicle screw fixation strength and the critical role of artificial intelligence.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2026Article
- Dose-Dependent Effects of Nickel on Skeletal Development: Physiological Necessity and the Threshold of Toxicity.International journal of molecular sciences · 2026Article
- Review
- Advancements in 3D printing technologies for personalized treatment of osteonecrosis of the femoral head.Materials today. Bio · 2025Review
- Comparison of hypoallergenic knee arthroplasties in patients with metal hypersensitivity versus standard arthroplasties in non-hypersensitivity patients: A scoping review.Journal of orthopaedics · 2025Review
- Titanium Cable Cerclage Increases the Load to Failure in Plate Osteosynthesis for Distal Femoral Fractures.Medicina (Kaunas, Lithuania) · 2024Article
- Treatment of failed cervical total disc replacements in a series of 53 cases and description of a management strategy.European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society · 2024Article
- Hierarchical Surface Pattern on Ni-Free Ti-Based Bulk Metallic Glass to Control Cell Interactions.Small (Weinheim an der Bergstrasse, Germany) · 2024Article
- NLRP3 inflammasome activation in response to metals.Frontiers in immunology · 2023Review
- Titanium nitride coating of pectus bar increases metal contamination after minimally-invasive repair of pectus excavatum.PloS one · 2023Article
- Article
- Metal Allergy: State-of-the-Art Mechanisms, Biomarkers, Hypersensitivity to Implants.Journal of clinical medicine · 2022Review
- The effect of Nickel hypersensitivity on the outcome of total knee arthroplasty and the value of skin patch testing: a systematic review.Arthroplasty (London, England) · 2022Review
- Systems, Properties, Surface Modification and Applications of Biodegradable Magnesium-Based Alloys: A Review.Materials (Basel, Switzerland) · 2022Review
- Hypoallergenic unicompartmental knee arthroplasty and return to sport: comparison between Oxidized Zirconium and Titanium Niobium Nitride.Acta bio-medica : Atenei Parmensis · 2022Article
- Hypersensitivity Reaction Post Laparoscopic Cholecystectomy Due to Retained Titanium Clips.Cureus · 2022Article
- Metallic Implants Used in Lumbar Interbody Fusion.Materials (Basel, Switzerland) · 2022Review
- Biologically modified implantation as therapeutic bioabsorbable materials for bone defect repair.Regenerative therapy · 2022Review
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
2 authors at 1 institution in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
Many of the metals used in orthopaedic surgical implants are immunologically active and can cause hypersensitivity reactions. Most of these metal hypersensitivity (MHS) reactions are type IV/delayed-type hypersensitivity reactions. The most common form of all metal hypersensitivity reactions is allergic contact dermatitis (ACD) caused by nickel. The purpose of this review is to examine the evidence regarding hypersensitivity to orthopaedic implants and provide current recommendations for evaluating these patients. We report on four case examples of patients where it was determined that metal allergy led to complications related to surgery. The most common symptoms for patients with MHS-associated failures are localized soft tissue reaction including delayed wound healing and/or recurrent wound issues. The best way to avoid postoperative issues is to routinely ask patients prior to surgery if they have any known MHS including problems with cosmetic jewelry. If this is known before surgery, titanium or carbon fiber implants should be used for fracture fixation and arthroplasty implantation choice should be modified based on the specific arthroplasty performed. MHS-associated failures are a diagnosis of exclusion and must be contemplated after judicious workup of localized soft tissue reaction including delayed wound healing and/or recurrent wound issues.
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Registered trials
Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.