Umile Giuseppe Longo, Giovanni Intermesoli, Raffaele Di Tommaso, Alberto Lalli, Bruno Violante, Michael T. Hirschmann
{"title":"全关节置换术中的金属敏感性：目前没有一种诊断测试是可靠的、敏感的和特异性的，不足以指导治疗决策！","authors":"Umile Giuseppe Longo, Giovanni Intermesoli, Raffaele Di Tommaso, Alberto Lalli, Bruno Violante, Michael T. Hirschmann","doi":"10.1002/ksa.12706","DOIUrl":null,"url":null,"abstract":"<div>\n \n \n <section>\n \n <h3> Purpose</h3>\n \n <p>This 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.</p>\n </section>\n \n <section>\n \n <h3> Methods</h3>\n \n <p>This 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.</p>\n </section>\n \n <section>\n \n <h3> Results</h3>\n \n <p>Twenty-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.</p>\n </section>\n \n <section>\n \n <h3> Conclusion</h3>\n \n <p>There 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.</p>\n </section>\n \n <section>\n \n <h3> Level of Evidence</h3>\n \n <p>Level III, systematic review.</p>\n </section>\n </div>","PeriodicalId":17880,"journal":{"name":"Knee Surgery, Sports Traumatology, Arthroscopy","volume":"33 9","pages":"3269-3285"},"PeriodicalIF":5.0000,"publicationDate":"2025-06-08","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://esskajournals.onlinelibrary.wiley.com/doi/epdf/10.1002/ksa.12706","citationCount":"0","resultStr":"{\"title\":\"Metal sensitivity in total joint arthroplasty: None of the current diagnostic tests are reliable, sensitive and specific enough to guide treatment decisions!\",\"authors\":\"Umile Giuseppe Longo, Giovanni Intermesoli, Raffaele Di Tommaso, Alberto Lalli, Bruno Violante, Michael T. Hirschmann\",\"doi\":\"10.1002/ksa.12706\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<div>\\n \\n \\n <section>\\n \\n <h3> Purpose</h3>\\n \\n <p>This 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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Methods</h3>\\n \\n <p>This 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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Results</h3>\\n \\n <p>Twenty-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.</p>\\n </section>\\n \\n <section>\\n \\n <h3> Conclusion</h3>\\n \\n <p>There is a lack of a standardised protocol for diagnosing metal hypersensitivity, leading to uncertainty regarding test selection and timing. 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Metal sensitivity in total joint arthroplasty: None of the current diagnostic tests are reliable, sensitive and specific enough to guide treatment decisions!
Purpose
This 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.
Methods
This 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.
Results
Twenty-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.
Conclusion
There 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.
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).
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