Bookshelf A hidden threat for dental implant patients? When they do occur, however, the associated pain, swelling, inflammation, and decreased range of motion can significantly impair the implant function. We present a case of a 28-year-old female with a chronic history of intermittent abdominal pain aggravated due to titanium allergy and retained foreign surgical body. The .gov means its official. Severe skin rashes. CT scan showed cystic collection of fluid with negative leukocyte scintigraphy. *List may not be exhaustive. Allergic reactions to staples, clips, and other metallic implants may be rare, but it can have adverse health effects on a patient. M. Tu and Y. Wu, Multiple allergies to metal alloys, Dermatologica Sinica, vol. If a glass of milk or slice of pizza causes swollen lips, hives, or other symptoms, you may have an allergy to casein, a protein in milk. = reference; THA = total hip arthroplasty; THR = total hip replacement. Bilateral pseudotumors anterior to joints (10 mo apart). The case also unfolds rare differential diagnoses to keep in mind when encountering a patient with abdominal pain and associated nonspecific symptoms. By Jonathan Cluett, MD Medicines to avoid in pregnancy When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. Allergy to Surgical Implants - PubMed The risk of surgical revision was not increased in patients with metal allergies, and the risk of metal allergy was not increased in patients who were operated on, in comparison with controls. Unable to load your collection due to an error, Unable to load your delegates due to an error. In most instances, these screws and plates do not create symptoms and remain permanently in the foot. Erythema, swelling, sterile effusions, pain with limitation of movement. When it is not an infection: metal allergy after the Nuss procedure for repair of pectus excavatum. Further Reading Some orthopedic implants contain small amounts of nickel, and there's been a concern that this may be an issue for nickel-sensitive people. J Prosthet Dent. The Body's Reaction to a Variety of Foreign Materials - Monib Health People with known metal allergies or sensitivities should tell their surgeon prior to knee replacement surgery. 2013, no. The woman also had a cholecystectomy back in 2007, and thats when she began experiencing symptoms including joint pain and tenderness, cramps, dry skin and hair, racing heart, hand tremors, and high blood pressure, among many others. 15, 2020. However, in some patients, hardware can become prominent or irritate a nearby . Hypersensitivity Reactions to Metallic Implants - Medscape Bone Joint J. PMC of weight loss in only four months of duration. Sneezing. 2015 Sep-Oct;3(5):683-95. doi: 10.1016/j.jaip.2015.07.011. Immunol Res. [6] This review aims to update the reader on the general aspects of this complex topic and to briefly discuss future challenges. Background Metal hypersensitivity, mostly documented in prosthesis implantation, is a rare complication after arthroplasty. No difference in positive patch-test results between restenosis and nonrestenosis groups after stent implantation (9% vs 10%). Unable to load your collection due to an error, Unable to load your delegates due to an error. On November 5, 2020, the embedded right colon foreign body was identified with fluoroscopic guidance (Figures 3(a) and 3(b)) and removed surgically (Figure 4). 2023 Dr. Stefano Sinicropi The information contained on this site is intended to provide only general education about spine surgery and conditions. Revision to titanium THR with ceramic-on-ceramic bearing led to symptom resolution. 145162, 2008. Also, more complex immune reactions may develop around the implants,. What are the symptoms of an allergic reaction to titanium? Lump in left groin associated with shooting pain, Bilateral MOM hip resurfacings (34 mo apart). They may want to consider an implant made of different materials, such as titanium. A blood test known as a nickel lymphocyte proliferation test is used to identify nickel sensitivity. Patients: All of her symptoms were initially suspected due to the infections mentioned above, and she was placed on various antibiotic therapy regimens consisting of ciprofloxacin, amoxicillin/clavulanate potassium, and sulfamethoxazole/trimethoprim. Implants made from titanium, ceramic, and coated parts are considered safe for people with metal allergies and unlikely to cause a reaction. doi:10.1016/j.jaip.2020.12.068, Wang Y, Dai S. Structural basis of metal hypersensitivity. Clipboard, Search History, and several other advanced features are temporarily unavailable. But sometimes issues do arise. Some people are prone to developing a response to various metals, such as skin sensitivity to jewelry or watches. 2016 Sep;31(9):1910-5. Some symptoms include chronic dermatitis and other reactions depending on the specific organ involved [10]. FOIA Copyright 2016 The Authors. Cite this: Cutaneous and Systemic Hypersensitivity Reactions to Metallic Implants-Medscape-Apr01,2011. Eczema most severe around the implant site, 3. 2016;24(2):106112. That said, in the discussion of metal implants in the body, these words are often used in the same discussion. However, around 10% to 15% are not satisfied for various reasons, including persistent pain and the loss of joint flexibility. 2022 Jun 21;14(6):e26167. We also use third-party cookies that help us analyze and understand how you use this website. Individuals should always consult a licensed and qualified health care provider for evaluation, diagnosis and treatment recommendations regarding their specific spine or other medical problems. eCollection 2023 Jun. Allergic responses to metals such as nickel, chromium, mercury, cobalt, and gold are widely recognized [1]. HSS J. Biological responses to metal implants: 2019. apr18 1, article bcr2013009070, 2013. The challenge with metal hypersensitivity is that the diagnosis is not always 100% certain. We describe a 69-year-old male for whom significant pathologic findings around dental implants had never been observed. Delayed Titanium Hypersensitivity and Retained Foreign Body - Hindawi led to symptom resolution; awaiting revision on other side. Unauthorized use of these marks is strictly prohibited. Careers. Read the article to learn more about what triggers this side effect and how you can ask help from your doctor to avoid any complications after your surgery. However, several studies have reported cases of metal allergy caused by titanium-containing materials. Signs and symptoms of metal hypersensitivity can range from mild to severe and generalized. However, in chronic cases of months to years after the operation, a CT scan is usually performed to rule out malignant tumors and possible fistula formations [13]. Although considered rare, a patient can potentially suffer from allergic reactions due to staples. Large periprosthetic cystic mass removed surgically. Exploring allergic reactions to medical implants | VailDaily.com Epub 2018 Apr 16. He exhibited allergic symptoms (eczema) after orthopedic surgery. These symptoms can make your child feel bad, but it's not life-threatening. Late onset infection can occur in some cases where you have some focus of infection causing bacteremia,and the sign symptoms include, redness. This can cause mild to significant local discomfort. The patients preop white blood cell (WBC) count was 5.2K/L, absolute neutrophil count was 3281 cells/L, and absolute lymphocyte count was 1284 cells/L. Allergic contact dermatitis caused by titanium screws and dental Patients can present with atopic dermatitis, pruritus, edema, urticaria, impaired healing fractures, pain, and necrosis of implants [ 3 ]. Copyright 2021 Molly S. Jain et al. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams. Additionally, standard surgical instruments such as electrodes, drains/catheters, retractors, or clamps can be left unrecognized after operations, especially in the abdominal space [13]. Between 10% and 15% of the general population is sensitive or allergic to nickel. Highest odds ratio for restenosis (5.41) were in nickel positives. July 9, 2021/ Erica Davies / Surgical Stapler Lawsuit / 0 comments. The first case of a dermatitis reaction over a stainless steel fracture plate was described in 1966. MeSH 201207, 2012. Please confirm that you would like to log out of Medscape. doi: 10.1371/journal.pone.0272283. Based on the level and proportion of immune cells in the sampleincluding leukocytes, eosinophils, and basophilsthe healthcare provider can diagnose DHT with a relatively high degree of confidence. The patient was referred to an infectious disease specialist and kept on a course of oral vancomycin and fidaxomicin. discharge. 12, no. A case by Little et al. Metals and their alloys could lead to immediate or delayed hypersensitivity reactions. 2016;98-B(4):437-41. doi:10.1302/0301-620X.98B4.36767, Teo WZW, Schalock PC. 2, pp. Revision to conventional THR led to resolution of pain. -, J Bone Joint Surg Am. Re: Allergy to metal screws. World J Orthop. A reaction to a knee replacement can appear months or even years after the initial surgery. Normal pelvic radiography. Restenosis occurred predominantly in patients with negative patch-test reaction to nickel. Her symptoms became chronic and progressed further to abdominal distension with increasing abdominal girth, fever, and several episodes of watery diarrhea. However, pre-surgical allergy testing cannot completely rule out a potential reaction. Revision to cementless total hip with ceramic-onceramic bearing led to symptom resolution. Therefore, diagnosing a sensitivity or allergy to a metal implant usually requires that the implant be removed. She was tested for Clostridium difficile infection and showed positive toxin B results confirming the diagnosis. We discuss the presentation, investigations, and treatment of this unusual case. 2018;14(2):192201. PMC Instead, metal hypersensitivities typically present as contact dermatitis. Iodine is essential for thyroid function, and an allergy to it would be life . When hardware issues become apparent, one of the first questions patients ask themselves is: Am I allergic to the hardware? In this post, we are going to talk about allergies as they relate to spinal hardware. In the past, it was believed that people who experienced an allergic reaction to substances containing iodine were allergic to the nutrient. But while reactions to surgical hardware and implants are rare, they do sometimes occur. It causes delayed clinical manifestations after 48 to 72 hours [10]. This article discusses knee replacement metal allergies and sensitivities. CT scan was promptly ordered to rule out the severe complication of toxic megacolon as a result of C. difficile infection. Dental implants; Metal allergy; Orthopedic surgery; Patch testing; Titanium. 1975 Nov 15;4(5993):376-8 An official website of the United States government. Metals including titanium can form haptenic antigens in their ionic form upon bonding with human cell native proteins and have the ability to potentiate degranulation of basophils and mast cells [3]. This site needs JavaScript to work properly. In an aging population, the putative association between metal allergy and device failure due to DTH may be a problem of growing significance. Some of the reported complications of pigtail catheter insertion include lung penetration during pleural effusion removal and entrapment of the catheter in the tricuspid valve leaflet during heart catheterization [8, 14, 15]. In other words, an orthopedic surgeon has to first exclude the more likely causes of continued pain or swelling around an implant such as infection, instability, implant loosening or tendinitis before considering hypersensitivity associated with an implant. This site needs JavaScript to work properly. Nasal congestion. doi:10.1007/s11420-016-9514-8. Nickel-stented patients: difference in restenosis rate between "allergic patients with restenosis (. does it exst? When they do occur, titanium allergy symptoms can range from mild to severe and can include: loosening of the implants (or implant failure) rash or hives. Hypersensitivity Reactions to Metallic Implants 4, pp. 2, 2020. The joint never fully fused and I had the stainless steel replaced first with a single titanium screw and cadaver bone graft and then a third . complete resolution; 2/17 awaiting revision; 3/17 coping well. National Library of Medicine If you log out, you will be required to enter your username and password the next time you visit. After the diagnosis of RFB, the preferred approach is to remove the RFB laparoscopically [13]. 2011;22(2):65-79. 4143, 2011. Type I hypersensitivity reaction may manifest as anaphylaxis causing urticarial plaques or papules on the skin [3]. The patient also started having low-grade fever, nausea, vomiting, joint pain, diffuse rash, and fatigue. Why Do Doctors Use Staples Instead of Stitches? If you have a known hypersensitivity to metal and are scheduled to undergo a total knee replacement, it is not clear if starting with a ceramic or titanium appliance is the best option. It requires a case-by-case evaluation weighing the potential benefits and risks. Unfortunately, the symptoms of metal implant sensitivity and allergy are not well defined. After removal of dental implants, the eczema disappeared completely. Bookshelf MN Although inflammation is the body's natural response to anything it considers foreign and harmful, it can cause pain and other symptoms if it occurs in the absence of a genuine threat. Before blame can be assigned to metal sensitivity or allergy, a thorough investigation must occur. Many types of metallic implants can cause cutaneous allergic reactions, from orthopedic and dental implants to cardiac stents and pacemakers. sharing sensitive information, make sure youre on a federal According to the U.S. Food and Drug Administration, some of the most common surgical staple and stapler malfunctions reported to the regulating agency include a malformed staple, failure of the stapler in firing the staple, misfiring, application of the staples to wrong tissue, and a surgeon applying the wrong size of staples to a tissue. Infrequent complications have been discussed in studies regarding pigtail catheter found on computerized tomography (CT) scan following a procedure. eCollection 2022 Jun. Some experts suspect a metal sensitivity or allergy might explain some of these post-operative complaints, particularly if the symptoms develop long after the implant is placed. Juliana L. Basko-Plluska; Jacob P. Thyssen; Peter C. Schalock. 1. 7373 France Ave S, Suite 408 You've successfully added to your alerts. Kohal RJ, Burkhardt F, Chevalier J, Patzelt SBM, Butz F. J Funct Biomater. Casein Allergy. 6, p. 630, 2014. Abi El Cheikh T, Vargas IM, Alili E, Tiesenga F. Cureus. sharing sensitive information, make sure youre on a federal After removal of dental implants, the eczema disappeared completely. Cookies collect information about your preferences and your devices and are used to make the site work as you expect it to, to understand how you interact with the site, and to show advertisements that are targeted to your interests. This case highlights the variable presentation of titanium allergy that clinicians should be vigilant for. She was diagnosed with pneumonia twice followed by two sinusitis episodes from January 2020 to March 2020. Prospective: 171 total stents; in-stent restenosis in 100% of patients with positive patch-test result but in only 57% of patients with negative patchtest results; no control group; only significant differences were for nickel and molybdenum. Diagnosing any metal allergy, including titanium allergy, has been complicated by various tests sensitivity and specificity. Allergy in total knee replacement. Commenting is limited to medical professionals. 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. The .gov means its official. There are many things that could be causing the healing. "Patient-ReportedMetalAllergy: A Risk Factor for Poor Outcomes After Total JointArthroplasty?" Fortunately, allergic responses to surgical implants are infrequent. It was only during a visit to the doctor in 2021 when she had a metal allergy test conducted, and it came back positive for reactivity to nickel, copper, and mercury. Sinus Issues. 2016 Jun;74(6):323-45. doi: 10.1111/cod.12565. Allergic or sensitive to metal? 5761, 1999. A few studies have also reported titanium as a potential allergen. Bioact Mater. Please use this form to submit your questions or comments on how to make this article more useful to clinicians. Lachiewicz PF, Watters TS, Jacobs JJ. Particularly for implants placed in the upper jaw, sinus problems may . Cara Beth Lee, MD, is a board-certified Orthopedic Surgeon with over 20 years of practice experience and subspecialty expertise in hip preservation surgery, focusing on patients with pre-arthritic hip disorders. 155162, 1999. 1 Patients with MHS reactions to implants typically have prolonged eczematous dermatitis.8 Although the majority of MHS reactions are localized, more widespread inflammation has been reported. Verywell Health's content is for informational and educational purposes only. The patient has been recommended to do a close follow-up for a few months to monitor her progress. Using skin patch tests and blood work, researchers identified metal sensitivity in nearly one-third of the study participants. suggested using 0.1% and 0.2% titanium sulfate solution and 0.1% and 0.2% titanium chloride as alternative reagents to titanium oxide in skin-patch testing [11]. Titanium has been considered to be a non-allergenic material. 2008 Jan;37(1):75-88. doi: 10.1007/s00132-007-1183-3. 15, 2019. Patch-tested at time of stenting and again in 6 mo; 6.9% were nickel allergic, but 37% developed instent restenosis; 1/3 nickel-allergic patients developed diffuse in-stent restenosis. Its symptomsitching, knee pain, skin rashes, joint stiffness, and swellingcan also have other causes, which makes this difficult to diagnose. Are IVC Filters dangerous? Most skin reactions are eczematous and allergic in nature, although urticarial, bullous, and vasculitic eruptions may occur. ", < 1% develop cutaneous reactions versus 2025% of patients who develop implant-induced metal sensitivity without any allergic skin manifestations. In our case, the patients nonspecific symptoms due to the titanium clips were quite different from the symptoms reported in other studies and may not wholly be attributable to titanium hypersensitivity since the patient had known allergic reactions to various other allergens as well. Changed to titaniumplated endoprostheses; symptoms resolved. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. In our case, the pigtail catheter was found as a retained surgical body lodged in the patients cecum. Metal sensitivities and allergies have been implicated in some situations involving pain or problems with orthopedic implants. Blog Hypersensitivity or allergy can occur after contact with various metals. Surgical exploration, revision to LCS prosthesis with bone graft and PMMA cement. Most of the usage of titanium is in the form of titanium dioxide. Department of Medicine, Section of Dermatology, The University of Chicago, Chicago, IL; the National Allergy Research Centre, Department of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, Denmark; and the Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Before Most skin reactions are eczematous and allergic in nature, although urticarial, bullous, and vasculitic eruptions may occur. Nickel is one of the most common allergens, and can cause local contact dermatitis characterized by itching and skin reddening. The most common symptoms of hypersensitivity to metals include: A small and localized hypersensitivity reaction can appear as a contact dermatitis where the skin may appear red, itchy, and swollen, sometimes accompanied with rashes and hives. The management of any metal allergy including titanium involves removing specific offending agents and avoiding potential triggers to hypersensitivity reactions. eCollection 2022. Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery. Rushing GD, Goretsky MJ, Gustin T, Morales M, Kelly RE Jr, Nuss D. J Pediatr Surg. Y. Nakashima, D. H. Sun, M. Trindade, W. Maloney, S. Goodman, and D. Schurman, Induction of macrophage C-C chemokine expression by titanium alloy and bone cement particles, Journal of Bone and Joint Surgery, vol. Sensitization to implant components is associated with joint replacement failure: identification and revision to nonallergenic hardware improves outcomes. If you or a loved one have any of these latter, more severe symptoms, these are indicators of when to go to the ER for an allergic reaction . The MELISA test has been known to be a more sensitive test to metal allergy but lacks specificity in the proliferation of lymphocytes [3]. Some implants are made of non-metal materials, such as ceramics, but there's limited data about their effectiveness and longevity. Basko-Plluska JL, Thyssen JP, Schalock PC. Other case reports by Shi et al., Tawil et al., and Towers et al., mentioned hypersensitivity reactions due to titanium in different surgical procedures such as anterior cervical discectomy, dental implants, and spinal fixation devices. A case of allergic reaction to surgical metal clips inserted for postoperative . It's rare for someone to need their metal implants removed due to a metal allergy or sensitivity. Titanium a strong metal that is known to hold fast to tissues and bone and tends to cause few problems for patients in surgeries. The patient had delayed hypersensitivity reaction to nickel in the past with erythematous rash formation and severe itching. official website and that any information you provide is encrypted Moreover, the patient was under multiple specialists care and had many hospitalizations and a history of various medication intake, including antibiotics and painkillers. Co-Cr-Mo = cobalt-chromium-molybdenum; LCS = low contact stress; MOM = metal-on-metal; PMMA = polymethylmethacrylate; pts = patients; Ref. "it appears that most patients who are metal-sensitive can safely receive an orthopedic implant containing that metal without the risk of cutaneous or systemic complications. The titanium screws used in the orthopedic surgery that he underwent were removed 1 year later, but the eczema remained. If you have an allergy or sensitivity to metals, ask your surgeon about knee replacements made with hypoallergenic materials. She had to be hospitalized with strict isolation to wait for her medication regimen to work along with the infusion of IV fluids. A rash after surgery may be due to contact with irritants or an allergic reaction to a medication. Titanium is extensively used in devices such as dental implants, pacemakers, and body piercing. Allergic to the metal screw in my foot after bunionectomy? 2023 Drugwatcher.org | All rights reserved. It can be challenging to diagnose and discover RFB due to the different manifestations of each case and nonspecific symptoms. Keywords: 1, pp. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies.