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Journal of Long-Term Effects of Medical Implants
SJR: 0.133 SNIP: 0.491 CiteScore™: 0.89

ISSN Imprimir: 1050-6934
ISSN En Línea: 1940-4379

Journal of Long-Term Effects of Medical Implants

DOI: 10.1615/JLongTermEffMedImplants.2019030060
pages 319-325

Failure of a Medial Unicompartmental Knee Replacement due to Metal Allergy

Alexandros P. Apostolopoulos
Orthopaedic and Trauma Department, Hellenic Red Cross Hospital, Athens, Greece; Trauma and Orthopaedic Department, Ealing Hospital, North West University Healthcare NHS Trust, London, United Kingdom
Theodore Balfousias
Trauma and Orthopaedic Department, East Surrey Hospital, Surrey and Sussex Healthcare, NHS Trust, Surrey United Kingdom RH15RH
Shamsul Khan
Trauma and Orthopaedic Department, East Surrey Hospital, Surrey and Sussex Healthcare, NHS Trust, Surrey United Kingdom RH15RH
Bala Srikanth
Trauma and Orthopaedic Department, East Surrey Hospital, Surrey and Sussex Healthcare, NHS Trust, Surrey United Kingdom RH15RH
George Tselentakis
Trauma and Orthopaedic Department, East Surrey Hospital, Surrey and Sussex Healthcare, NHS Trust, Surrey United Kingdom RH15RH

SINOPSIS

Metal hypersensitivity is an uncommon complication of knee arthroplasty that can lead to significant functional impairment and aseptic prosthesis failure. We describe the case of a 65-yr-old female patient who presented with persistent pain, swelling, and instability 1 yr after medial unicompartmental knee arthroplasty (UKA). The patient had no history of trauma or fall. The initial clinical examination showed good range of movement in the knee joint and no signs of infection or inflammation. Initial radiographs did not reveal aseptic loosening of the implant. Inflammatory markers were normal and the patient was sent for a bone scintigraphy that revealed increased uptake of the femoral implant. Pain deteriorated during the proceeding weeks, and repeated radiographs revealed loosening and dislocation of the femoral implant. We performed a nickel lymphocyte proliferation skin allergy test that resulted in a positive reaction. Revision total knee arthroplasty was performed using an oxynium (zirconium metal alloy) implant with intraoperative tissue pathology and postoperative leukocyte transformation testing that confirmed metal hypersensitivity as the cause for aseptic implant failure. This case report demonstrates that clinical and laboratory signs suggesting metal hypersensitivity in knee arthroplasty can suggest early loosening and failure of the implant.


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