What is it about?
This case report describes a patient who developed rashes over the left knee 5 days after she had an operation to replace the left knee with a metal implant due to underlying osteoarthritis. The rashes subsequently generalized and spread to the rest of the body. She was treated with steroid creams and tablets with resolution of the rashes. A patch testing showed a strong positive reaction to gold and nickel (confirming the contact allergy) along with weak positive reactions to copper, palladium, rhodium, titanium, vanadium, zinc, and hydroquinone. As the rashes did not return after the treatment with steroids, she did not require a second operation to remove the implant.
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Why is it important?
Patients may develop allergic reactions to various components of surgical implants including metal components. However these allergies may sometimes resolve without having to remove the surgical implant.
Perspectives
This case report led me to study and explore in greater detail the mechanisms of metal implant allergy. There is a lot that is still unclear, such as whether patients with a metal allergy are more likely to develop failure of the implant, or whether there is any role of performing a patch test prior to the surgery itself.
Ellie Choi
National University of Singapore
I learnt that the presence of a metal hypersensivity reaction can be managed conservatively with good outcomes, and is not an indication for removal of the metal implant. However, if implant failure occurs in patients with metal hypersenstivity reaction, discussion with the orthopedic surgeons should be made in consideration of removal or replacement of the implant.
Yang Sun
Read the Original
This page is a summary of: Cutaneous Metal Hypersensitivity Reaction, Case Reports in Dermatology, March 2022, Karger Publishers,
DOI: 10.1159/000523740.
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