Nickel allergy does not correlate with function after total knee arthroplasty

IF 3.3 2区医学 Q1 ORTHOPEDICS

Knee Surgery, Sports Traumatology, Arthroscopy Pub Date : 2024-08-27 DOI:10.1002/ksa.12448

George Chimento, Jimmy Daher, Bhumit Desai, Cruz Velasco-Gonzalez

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引用次数: 0

Abstract

Purpose

The purpose of this study is to determine if there is a relationship between clinical outcomes and nickel allergy by evaluating asymptomatic total knee arthroplasty (TKA) patients with well-functioning implants through quantitative metal allergy (MA) testing.

Methods

A prospective case series was performed on 50 patients with well-functioning TKA of various implant types. Inclusion criteria included primary TKA with a minimum 12-month follow-up and Oxford knee score (OKS) ≥ 40. A commercially available Lymphocyte Transformation Test measured the amount of a hypersensitivity lymphocyte immune response after exposure to a particular antigen. MA results were stratified based on the stimulation index (SI). The Cochran–Mantel–Haenzel test was used to test the homogeneity of metal reactivities. The Wilcoxon–Mann–Whitney test was used to compare individual metal SI by gender and the association of OKS and metal SI was ascertained with the Spearman correlation.

Results

Nickel, cobalt, and chromium do not have the same reactivity scores (p < 0.001), and only nickel showed reactive/highly reactive scores. Females were found to have 3.41 times the odds of males for higher Ni reactivity (p = 0.0295, odds ratio [OR], 95% confidence interval [CI] = 3.41 [1.13–10.3]) only. Clinically, there was no correlation between metal SI and OKS score by metal (Ni rho = −0.1779; Co rho = −0.0036; Cr rho = −0.1748).

Conclusion

This is the first study looking at MA in well-functioning TKA. There is no correlation between clinical results and nickel reactivity. Surgeons should exercise caution when revising a painful or poorly functioning TKA based solely on a ‘positive’ Nickel Allergy test and look for other possible reasons for failure.

Level of Evidence

Level II.

查看原文本刊更多论文

镍过敏与全膝关节置换术后的功能无关。

目的：本研究的目的是通过定量金属过敏（MA）测试，评估无症状且植入物功能良好的全膝关节置换术（TKA）患者，从而确定临床结果与镍过敏之间是否存在关系：方法：对 50 名使用不同类型植入物、功能良好的 TKA 患者进行了前瞻性病例系列研究。纳入标准包括至少随访 12 个月且牛津膝关节评分 (OKS) ≥ 40 分的初次 TKA 患者。淋巴细胞转化测试（Lymphocyte Transformation Test）用于测量暴露于特定抗原后超敏淋巴细胞免疫反应的数量。MA 结果根据刺激指数 (SI) 进行分层。Cochran-Mantel-Haenzel检验用于检测金属反应的同质性。Wilcoxon-Mann-Whitney 检验用于比较不同性别的单个金属 SI，Spearman 相关性检验用于确定 OKS 与金属 SI 的关联：结果：镍、钴和铬的反应性得分并不相同（p 结论：这是第一项研究 MAS 与金属反应性得分之间关系的研究：这是首次对功能良好的 TKA 中的 MA 进行研究。临床结果与镍反应性之间没有关联。外科医生在仅根据 "阳性 "镍过敏测试对疼痛或功能不良的 TKA 进行修复时应谨慎，并寻找其他可能的失败原因：证据等级：二级。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Knee Surgery, Sports Traumatology, Arthroscopy 医学-外科

CiteScore

8.10

自引率

18.40%

发文量

418

审稿时长

2 months

期刊介绍： Few other areas of orthopedic surgery and traumatology have undergone such a dramatic evolution in the last 10 years as knee surgery, arthroscopy and sports traumatology. Ranked among the top 33% of journals in both Orthopedics and Sports Sciences, the goal of this European journal is to publish papers about innovative knee surgery, sports trauma surgery and arthroscopy. Each issue features a series of peer-reviewed articles that deal with diagnosis and management and with basic research. Each issue also contains at least one review article about an important clinical problem. Case presentations or short notes about technical innovations are also accepted for publication. The articles cover all aspects of knee surgery and all types of sports trauma; in addition, epidemiology, diagnosis, treatment and prevention, and all types of arthroscopy (not only the knee but also the shoulder, elbow, wrist, hip, ankle, etc.) are addressed. Articles on new diagnostic techniques such as MRI and ultrasound and high-quality articles about the biomechanics of joints, muscles and tendons are included. Although this is largely a clinical journal, it is also open to basic research with clinical relevance. Because the journal is supported by a distinguished European Editorial Board, assisted by an international Advisory Board, you can be assured that the journal maintains the highest standards. Official Clinical Journal of the European Society of Sports Traumatology, Knee Surgery and Arthroscopy (ESSKA).