Hypersensitivity reaction after total knee arthroplasty caused by titanium nitride coated implant: A case report

Background

Hypersensitivity reaction to implants after total knee arthroplasty (TKA) is an area-specific complication. Although titanium nitride is relatively safe, hypersensitivity reaction may occur and revision surgery might be necessary.

Case presentation

A 60-year-old man presented with persistent swelling and pain that occurred after TKA. The patient had undergone TKA before 3 years and open debridement was performed once due to persistent swelling before his visit to our hospital. After eliminating all the possible causes of persistent swelling after TKA, a skin patch test was performed, which revealed a positive reaction to titanium nitride. A revision TKA was performed using an implant made of a material not known to cause hypersensitivity reaction. One year after revision TKA, significant reduction was observed in pain and swelling did not recur.

Conclusion

Metal hypersensitivity reaction after TKA is a rare occurrence and is difficult to diagnose because the symptom is non-specific. In this study, we reported a case of hypersensitivity reaction to a titanium nitride coated implant, which is considered relatively safe. It is important to eliminate other causes such as infection and implant loosening in cases of painful swelling that occurs after TKA. If a revision surgery is indicated, the treatment should be implemented with a material that does not cause hypersensitivity reaction.