SynthesisKnee surgery, sports traumatology, arthroscopy : official journal of the ESSKA2025
Metal sensitivity in total joint arthroplasty: None of the current diagnostic tests are reliable, sensitive and specific enough to guide treatment decisions!
Synthesis in Knee surgery, sports traumatology, arthroscopy : official journal of the ESSKA, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 3 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
3 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
- Suspected Hypersensitivity Reaction to Titanium Screws Following Kalish Osteotomy for Hallux Valgus.Cureus · 2026Article
- Metal Allergies in Total Shoulder Arthroplasty: A Scoping Review and Clinical Update.JB & JS open accessReview
Corrections and comments
PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.
Authors and funding
6 authors.
Funding
No grant is acknowledged in the PubMed record.
Abstract
purposeThis systematic review was conducted to evaluate the current literature on metal hypersensitivity in patients undergoing joint arthroplasty. The aims of the study were to report diagnostic tools used to assess metal hypersensitivity and to report complications arising in patients who are hypersensitive to nickel or other metals performing joint arthroplasty. Given the potential impact on implant longevity and patient outcomes, understanding the clinical relevance of metal hypersensitivity is crucial for optimising surgical decision-making.
methodsThis systematic review adheres to PRISMA guidelines and evaluates the variability in diagnostic approaches and the challenges in clinical management. Included in this review were studies involving patients sensitive to nickel or other metals undergoing joint arthroplasty. Eligibility criteria focused on commonly employed diagnostic tools and associated complications. A comprehensive literature search was conducted across Medline, EMBASE, Scopus, CINAHL, and CENTRAL databases. The methodological quality of the included studies was assessed using the Joanna Briggs Institute Critical Appraisal tool for case series and the ROBINS-I tool for case-control studies.
resultsTwenty-four articles met the inclusion criteria and were included in this systematic review. A total of 4865 patients undergoing joint arthroplasty were selected. Diagnostic tools included patch testing, lymphocyte transformation test (LTT), and medical history assessment. Variability in time point of testing and diagnostic protocols was noted. Complications including joint pain, swelling, reduced range of motion, and implant failure were reported in 12 studies. Clinical outcomes varied widely: some studies showing no significant differences between hypersensitive and non-hypersensitive patients, while others reported increased pain and reduced joint function.
conclusionThere is a lack of a standardised protocol for diagnosing metal hypersensitivity, leading to uncertainty regarding test selection and timing. This inconsistency leads to variability in reported outcomes, with limited studies focusing on post-surgical hypersensitivity in patients. LEVEL OF EVIDENCE: Level III, systematic review.
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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.