ArticleBone & joint open2021
Metal allergy in primary and revision total knee arthroplasty : a scoping review and evidence-based practical approach.
Article in Bone & joint open, 2021. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 13 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
13 citing papers in PubMed, 1 synthesis or guideline pooled it, 33 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
- Increased 30-Day Readmission Rates in Total Knee Arthroplasty Patients Using Hypoallergenic Implants.Journal of the American Academy of Orthopaedic Surgeons. Global research & reviews · 2026Article
- Establishing the Frequency of the HLA Class II Pseudotumour 'at Risk' Genotype: A Pilot Epidemiologic Analysis.ANZ journal of surgery · 2025Article
- Mid-Term Results of a Cemented Titanium-Niobium Nitride-Coated Mobile Knee in Primary Total Knee Arthroplasty.Journal of clinical medicine · 2025Article
- Comparison of hypoallergenic knee arthroplasties in patients with metal hypersensitivity versus standard arthroplasties in non-hypersensitivity patients: A scoping review.Journal of orthopaedics · 2025Review
- Metal Hypersensitivity in Patients With Failure of Joint Prosthesis Treatment.Journal of immunology research · 2025Article
- Hypoallergenic Knee Implant Usage and Clinical Outcomes: Are They Safe and Effective?Arthroplasty today · 2024Article
- Long-term clinical results of alumina ceramic medial pivot total knee arthroplasty: a 10-year follow-up study.Arthroplasty (London, England) · 2023Article
- Ceramic Coatings Confer No Survivorship Advantages in Total Knee Arthroplasty-A Single-Center Series of 1641 Knees.Arthroplasty today · 2023Article
- Poor Correlation Among Metal Hypersensitivity Testing Modalities and Inferior Patient-Reported Outcomes After Primary and Revision Total Knee Arthroplasties.Arthroplasty today · 2022Article
- 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
- Synchrotron-based characterization of arthroprosthetic CoCrMo particles in human bone marrow.Journal of materials science. Materials in medicine · 2022Article
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
3 authors at 3 institutions in 1 country.
Funding
No grant is acknowledged in the PubMed record.
Abstract
aimsMetal allergy in knee arthroplasty patients is a controversial topic. We aimed to conduct a scoping review to clarify the management of metal allergy in primary and revision total knee arthroplasty (TKA).
methodsStudies were identified by searching electronic databases: Cochrane Central Register of Controlled Trials, Ovid MEDLINE, and Embase, from their inception to November 2020, for studies evaluating TKA patients with metal hypersensitivity/allergy. All studies reporting on diagnosing or managing metal hypersensitivity in TKA were included. Data were extracted and summarized based on study design, study population, interventions and outcomes. A practical guide is then formulated based on the available evidence.
resultsWe included 38 heterogeneous studies (two randomized controlled trials, six comparative studies, 19 case series, and 11 case reports). The evidence indicates that metal hypersensitivity is a rare complication with some histopathological features leading to pain and dissatisfaction with no reliable screening tests preoperatively. Hypoallergenic implants are viable alternatives for patients with self-reported/confirmed metal hypersensitivity if declared preoperatively; however, concerns remain over their long-term outcomes with ceramic implants outperforming titanium nitride-coated implants and informed consent is paramount. For patients presenting with painful TKA, metal hypersensitivity is a diagnosis of exclusion where patch skin testing, lymphocyte transformation test, and synovial biopsies are useful adjuncts before revision surgery is undertaken to hypoallergenic implants with shared decision-making and informed consent.
conclusionUsing the limited available evidence in the literature, we provide a practical approach to metal hypersensitivity in TKA patients. Future national/registry-based studies are needed to identify the scale of metal hypersensitivity, agreed diagnostic criteria, and management strategies. Cite this article:
Indexed as
Identifiers
What OpenQuestion holds
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.