切换至 "中华医学电子期刊资源库"

中华关节外科杂志(电子版) ›› 2021, Vol. 15 ›› Issue (06) : 700 -706. doi: 10.3877/cma.j.issn.1674-134X.2021.06.008

综述

金属超敏反应在全膝关节置换术中的研究进展
余鹏1, 孙长鲛2,(), 蔡谞2   
  1. 1. 430081 武汉科技大学医院
    2. 102218 清华大学附属北京清华长庚医院骨科,清华大学临床医学院
  • 收稿日期:2020-10-27 出版日期:2021-12-01
  • 通信作者: 孙长鲛

Research progress of metal hypersensitivity in total knee arthroplasty

Peng Yu1, Changjiao Sun2,(), Xu Cai2   

  1. 1. Department of Orthopedic, Wuhan University of Science and Technology Hospital, Wuhan 430081, China
    2. Department of Orthopedic, Beijing Tsinghua Changgung Hospital, School of Clinical Medicine, Tsinghua University, Beijing 102218, China
  • Received:2020-10-27 Published:2021-12-01
  • Corresponding author: Changjiao Sun
引用本文:

余鹏, 孙长鲛, 蔡谞. 金属超敏反应在全膝关节置换术中的研究进展[J/OL]. 中华关节外科杂志(电子版), 2021, 15(06): 700-706.

Peng Yu, Changjiao Sun, Xu Cai. Research progress of metal hypersensitivity in total knee arthroplasty[J/OL]. Chinese Journal of Joint Surgery(Electronic Edition), 2021, 15(06): 700-706.

全膝关节置换术临床效果良好,但仍有20%的患者对临床结果不满意。这些患者虽然存在疼痛但膝关节假体功能良好。在排除了其他潜在原因后,要考虑到可能与金属超敏反应(MHS)有关。MHS实际是对假体植入物金属(通常是镍和钴铬合金)的Ⅳ型超敏反应。通常表现为假体周围关节疼痛和肿胀以及皮肤出现湿疹性皮炎。虽然MHS是膝关节置换术后罕见的并发症,但该反应在一般人群的发生率约为15%,并且在最近几十年中,随着膝关节置换术的增加,金属超敏反应的现象也在增加。.这篇综述的目的是对现有文献进行回顾分析,以便更好地了解MHS的病理生理,临床表现,诊断标准,检测方法,治疗方法和防过敏性假体。

Total knee arthroplasty is a common procedure, with extremely good clinical results. Despite this success, it produces 20% unsatisfactory results. These patients complained pain in otherwise well implanted and aligned prostheses. Metal hypersensitivity (MHS) is a rare complication of total joint arthroplasty that has been linked to prosthetic device failure when other potential causes have been ruled out. It has been described as a type IV hypersensitivity reaction to the metals comprising prosthetic implants, often nickel and cobalt-chromium. Patients suffering from this condition have reported periprosthetic joint pain and swelling as well as cutaneous, eczematous dermatitis. Although MHS is rare, hypersensitivity to metals in the general population has an incidence of about 15%, and in rising also for the higher number of joint replacements in the last decades. The purpose of this review was to conduct an analysis of existing literature in order to get a better understanding of the pathophysiology, clinical syndromes diagnosis, detection method, management of MHS and "hypersensitivity-friendly" implants

图1 TKA(全膝关节置换)术后金属超敏反应治疗流程
[1]
Castorina S, Guglielmino C, Castrogiovanni P, et al. Clinical evidence of traditional vs fast track recovery methodologies after total arthroplasty for osteoarthritic knee treatment. A retrospective observational study[J]. Muscles Ligaments Tendons J, 2017, 7(3): 504-513.
[2]
Pacheco KA. Allergy to surgical implants[J]. J Allergy Clin Immunol Pract, 2015, 3(5): 683-695.
[3]
黄自强,孙长鲛. 膝关节置换患者手术失败原因的分析[J]. 中华医学杂志, 2015, 20(95): 1606-1609.
[4]
Pitta M, Esposito CI, Li Z, et al. Failure after modern total knee arthroplasty: a prospective study of 18,065 knees[J]. J Arthroplasty, 2018, 33(2): 407-414.
[5]
Gupta R, Phan D, Schwarzkopf R. Total knee arthroplasty failure induced by metal hypersensitivity[J]. Am J Case Rep, 2015, 16: 542-547.
[6]
Hallab N, Merritt K, Jacobs JJ. Metal sensitivity in patients with orthopaedic implants[J]. J Bone Joint Surg Am, 2001, 83(3): 428-436.
[7]
Schäfer T, Böhler E, Ruhdorfer S, et al. Epidemiology of contact allergy in adults[J]. Allergy, 2001, 56(12): 1192-1196.
[8]
Menné T, Nieboer E. Metal contact dermatitis: a common and potentially debilitating disease[J]. Endeavour, 1989, 13(3): 117-122.
[9]
Thienpont E, Berger Y. No allergic reaction after TKA in a chrome-cobalt-nickel-sensitive patient: case report and review of the literature[J]. Knee Surg Sports Traumatol Arthrosc, 2013, 21(3): 636-640.
[10]
Mckenzie AW, Aitken CV, Ridsdill-Smith R. Urticaria after insertion of Smith-Petersen Vitallium nail[J/OL]. Br Med J, 1967, 4(5570): 36. DOI:org/10.1136/bmj.4.5570.36.
[11]
Cadosch D, Chan E, Gautschi OP, et al. Bio-corrosion of stainless steel by osteoclasts-in vitro evidence[J]. J Orthop Res, 2009, 27(7): 841-846.
[12]
Münch HJ, Jacobsen SS, Olesen JT, et al. The association between metal allergy, total knee arthroplasty, and revision: study based on the Danish Knee Arthroplasty Register[J]. Acta Orthop, 2015, 86(3): 378-383.
[13]
Mitchelson AJ, Wilson CJ, Mihalko WM, et al. Biomaterial hypersensitivity: is it real? Supportive evidence and approach considerations for metal allergic patients following total knee arthroplasty[J/OL]. Biomed Res Int, 2015, 2015: 137287. DOI:org/10.1155/2015/137287.
[14]
Plummer DR, Yi PH, Jacobs JJ, et al. Aseptic lymphocytic-dominated vasculitis-associated lesions scores do not correlate with metal ion levels or unreadable synovial fluid white blood cell counts[J]. J Arthroplasty, 2017, 32(4): 1340-1343.
[15]
Berend KR, Morris MJ, Adams JB, et al. Metal-on-metal hip arthroplasty: going, going, gone... - affirms[J]. J Bone Joint Surg Br, 2012, 94(11 Suppl A): 75-77.
[16]
Carulli C, Villano M, Bucciarelli G, et al. Painful knee arthroplasty: definition and overview[J]. Clin Cases Miner Bone Metab, 2011, 8(2): 23-25.
[17]
Villano M, Carulli C, Puccini S, et al. Painful knee prosthesis: surgical approach[J]. Clin Cases Miner Bone Metab, 2011, 8(2): 26-28.
[18]
Hallab NJ, Caicedo M, Finnegan A, et al. Th1 type lymphocyte reactivity to metals in patients with total hip arthroplasty[J]. J Orthop Surg Res, 2008, 3: 6-17.
[19]
Carossino AM, Carulli C, Ciuffi S, et al. Hypersensitivity reactions to metal implants: laboratory options[J]. BMC Musculoskelet Disord, 2016, 17(1): 486-499.
[20]
Hallab NJ, Mikecz K, Jacobs JJ. A triple assay technique for the evaluation of metal-induced, delayed-type hypersensitivity responses in patients with or receiving total joint arthroplasty[J]. J Biomed Mater Res, 2000, 53(5): 480-489.
[21]
Innocenti M, Carulli C, Matassi F, et al. Total knee arthroplasty in patients with hypersensitivity to metals[J]. Int Orthop, 2014, 38(2): 329-333.
[22]
Lachiewicz PF, Watters TS, Jacobs JJ. Metal hypersensitivity and total knee arthroplasty[J]. J Am Acad Orthop Surg, 2016, 24(2): 106-112.
[23]
Thakur RR, Ast MP, Mcgraw M, et al. Severe persistent synovitis after cobalt-chromium total knee arthroplasty requiring revision[J/OL]. Orthopedics, 2013, 36(4): e520-e524. DOI:org/10.3928/01477447-20130327-34.
[24]
Niki Y, Matsumoto H, Otani T, et al. Screening for symptomatic metal sensitivity: a prospective study of 92 patients undergoing total knee arthroplasty[J]. Biomaterials, 2005, 26(9): 1019-1026.
[25]
Verma SB, Mody B, Gawkrodger DJ. Dermatitis on the knee following knee replacement: a minority of cases show contact allergy to chromate, cobalt or nickel but a causal association is unproven[J]. Contact Dermatitis, 2006, 54(4): 228-229.
[26]
Akil S, Newman JM, Shah NV, et al. Metal hypersensitivity in total hip and knee arthroplasty: current concepts[J]. J Clin Orthop Trauma, 2018, 9(1): 3-6.
[27]
Gao X, He RX, Yan SG, et al. Dermatitis associated with chromium following total knee arthroplasty[J//OL]. J Arthroplasty, 2011, 26(4): 665.e13-e16. DOI:org/10.1016/j.arth.2010.06.002.
[28]
Post ZD, Orozco FR, Ong AC. Metal sensitivity after TKA presenting with systemic dermatitis and hair loss[J/OL]. Orthopedics, 2013, 36(4): e525-e528. DOI:org/10.3928/01477447-20130327-35.
[29]
Zeng Y, Feng W. Metal allergy in patients with total hip replacement: a review[J]. J Int Med Res, 2013, 41(2): 247-252.
[30]
Willert HG, Buchhorn GH, Fayyazi A, et al. Metal-on-metal bearings and hypersensitivity in patients with artificial hip joints. A clinical and histomorphological study[J]. J Bone Joint Surg Am, 2005, 87(1): 28-36.
[31]
Schalock PC, Crawford G, Nedorost S, et al. Patch testing for evaluation of hypersensitivity to implanted metal devices: a perspective from the American Contact Dermatitis Society[J]. Dermatitis, 2016, 27(5): 241-247.
[32]
Thyssen JP, Menné T, Schalock PC, et al. Pragmatic approach to the clinical work-up of patients with putative allergic disease to metallic orthopaedic implants before and after surgery[J]. Br J Dermatol, 2011, 164(3): 473-478.
[33]
Hallab NJ, Caicedo M, Epstein R, et al. In vitro reactivity to implant metals demonstrates a person-dependent association with both T-cell and B-cell activation[J]. J Biomed Mater Res A, 2010, 92(2): 667-682.
[34]
Wilkinson DS, Fregert S, Magnusson B, et al. Terminology of contact dermatitis[J]. Acta Derm Venereol, 1970, 50(4): 287-292.
[35]
Everness KM, Gawkrodger DJ, Botham PA, et al. The discrimination between nickel-sensitive and non-nickel-sensitive subjects by an in vitro lymphocyte transformation test[J]. Br J Dermatol, 1990, 122(3): 293-298.
[36]
Drake LA, Dorner W, Goltz RW, et al. Guidelines of care for contact dermatitis. Committee on Guidelines of Care[J]. J Am Acad Dermatol, 1995, 32(1): 109-113.
[37]
Dickel H, Altmeyer P, Brasch J. "New" techniques for more sensitive patch testing?[J]. J Dtsch Dermatol Ges, 2011, 9(11): 889-896.
[38]
Kręcisz B, Kieć-Świerczyńska M, Chomiczewska-Skóra D. Allergy to orthopedic metal implants - a prospective study[J]. Int J Occup Med Environ Health, 2012, 25(4): 463-469.
[39]
Wawrzynski J, Gil JA, Goodman AD, et al. Hypersensitivity to orthopedic implants: a review of the literature[J]. Rheumatol Ther, 2017, 4(1): 45-56.
[40]
Schalock PC, Menné T, Johansen JD, et al. Hypersensitivity reactions to metallic implants - diagnostic algorithm and suggested patch test series for clinical use[J]. Contact Dermatitis, 2012, 66(1): 4-19.
[41]
Cederbrant K, Hultman P, Marcusson JA, et al. In vitro lymphocyte proliferation as compared to patch test using gold, palladium and nickel[J]. Int Arch Allergy Immunol, 1997, 112(3): 212-217.
[42]
Hallab NJ, Jacobs JJ. Biologic effects of implant debris[J]. Bull NYU Hosp Jt Dis, 2009, 67(2): 182-188.
[43]
Granchi D, Cenni E, Giunti A, et al. Metal hypersensitivity testing in patients undergoing joint replacement: a systematic review[J]. J Bone Joint Surg Br, 2012, 94(8): 1126-1134.
[44]
Lützner J, Hartmann A, Dinnebier G, et al. Metal hypersensitivity and metal ion levels in patients with coated or uncoated total knee arthroplasty: a randomised controlled study[J]. Int Orthop, 2013, 37(10): 1925-1931.
[45]
Thomas P, Braathen LR, Dörig M, et al. Increased metal allergy in patients with failed metal-on-metal hip arthroplasty and peri-implant T-lymphocytic inflammation[J]. Allergy, 2009, 64(8): 1157-1165.
[46]
Pinson ML, Coop CA, Webb CN. Metal hypersensitivity in total joint arthroplasty[J]. Ann Allergy Asthma Immunol, 2014, 113(2): 131-136.
[47]
Ries MD, Salehi A, Widding K, et al. Polyethylene wear performance of oxidized zirconium and cobalt-chromium knee components under abrasive conditions[J]. J Bone Joint Surg Am, 2002, 84-A Suppl 2: 129-135.
[48]
Ezzet KA, Hermida JC, Colwell CW, Jr., et al. Oxidized zirconium femoral components reduce polyethylene wear in a knee wear simulator[J]. Clin Orthop Relat Res, 2004, (428): 120-124.
[49]
Patel AM, Spector M. Tribological evaluation of oxidized zirconium using an articular cartilage counterface: a novel material for potential use in hemiarthroplasty[J]. Biomaterials, 1997, 18(5): 441-447.
[50]
Van Hove RP, Brohet RM, Van Royen BJ, et al. No clinical benefit of titanium nitride coating in cementless mobile-bearing total knee arthroplasty[J]. Knee Surg Sports Traumatol Arthrosc, 2015, 23(6): 1833-1840.
[51]
Innocenti M, Vieri B, Melani T, et al. Metal hypersensitivity after knee arthroplasty: fact or fiction?[J]. Acta Biomed, 2017, 88(2s): 78-83.
[52]
Hui C, Salmon L, Maeno S, et al. Five-year comparison of oxidized zirconium and cobalt-chromium femoral components in total knee arthroplasty: a randomized controlled trial[J]. J Bone Joint Surg Am, 2011, 93(7): 624-630.
[53]
Innocenti M, Civinini R, Carulli C, et al. The 5-year results of an oxidized zirconium femoral component for TKA[J]. Clin Orthop Relat Res, 2010, 468(5): 1258-1263.
[54]
Hofer JK, Ezzet KA. A minimum 5-year follow-up of an oxidized zirconium femoral prosthesis used for total knee arthroplasty[J]. Knee, 2014, 21(1): 168-171.
[55]
Laskin RS. An oxidized Zr ceramic surfaced femoral component for total knee arthroplasty[J]. Clin Orthop Relat Res, 2003, (416): 191-196.
[56]
Solarino G, Piconi C, De Santis V, et al. Ceramic total knee arthroplasty: ready to go?[J]. Joints, 2017, 5(4): 224-228.
[57]
Bergschmidt P, Bader R, Ganzer D, et al. Ceramic femoral components in total knee arthroplasty - two year follow-up results of an international prospective multi-centre study[J]. Open Orthop J, 2012, 6: 172-178.
[58]
Bergschmidt P, Ellenrieder M, Bader R, et al. Prospective comparative clinical study of ceramic and metallic femoral components for total knee arthroplasty over a five-year follow-up period[J]. Knee, 2016, 23(5): 871-876.
[59]
Bergschmidt P, Bader R, Kluess D, et al. Total knee replacement system with a ceramic femoral component versus two traditional metallic designs: a prospective short-term study[J]. J Orthop Surg (Hong Kong), 2013, 21(3): 294-299.
[60]
Nakamura S, Kobayashi M, Ito H, et al. The Bi-Surface total knee arthroplasty: minimum 10-year follow-up study[J]. Knee, 2010, 17(4): 274-278.
[61]
Nakamura S, Ito H, Nakamura K, et al. Long-term durability of ceramic tri-condylar knee implants: a minimum 15-year follow-up[J]. J Arthroplasty, 2017, 32(6): 1874-1879.
[62]
Gioe TJ, Maheshwari AV. The all-polyethylene tibial component in primary total knee arthroplasty[J]. J Bone Joint Surg Am, 2010, 92(2): 478-487.
[63]
Nouta K A, Verra W C, Pijls B G, et al. All-polyethylene tibial components are equal to metal-backed components: systematic review and meta-regression[J]. Clin Orthop Relat Res, 2012, 470(12): 3549-3559.
[64]
Thienpont E. Titanium niobium nitride knee implants are not inferior to chrome cobalt components for primary total knee arthroplasty[J]. Arch Orthop Trauma Surg, 2015, 135(12): 1749-1754.
[65]
Wisbey A, Gregson PJ, Tuke M. Application of PVD TiN coating to Co-Cr-Mo based surgical implants[J]. Biomaterials, 1987, 8(6): 477-480.
[66]
Galetz MC, Seiferth SH, Theile B, et al. Potential for adhesive wear in friction couples of UHMWPE running against oxidized zirconium, titanium nitride coatings, and cobalt-chromium alloys[J]. J Biomed Mater Res B Appl Biomater, 2010, 93(2): 468-475.
[67]
Goldberg JR, Gilbert JL. The electrochemical and mechanical behavior of passivated and TiN/AlN-coated CoCrMo and Ti6Al4V alloys[J]. Biomaterials, 2004, 25(5): 851-864.
[68]
Pappas MJ, Makris G, Buechel FF. Titanium nitride ceramic film against polyethylene. A 48 million cycle wear test[J]. Clin Orthop Relat Res, 1995, (317): 64-70.
[69]
Choi NY, In Y, Bae JH, et al. Are midterm patient-reported outcome measures between rotating-platform mobile-bearing prosthesis and medial-pivot prosthesis different? A minimum of 5-year follow-up study[J]. J Arthroplasty, 2017, 32(3): 824-829.
[70]
Thomsen M, Rozak M, Thomas P. Pain in a chromium-allergic patient with total knee arthroplasty: disappearance of symptoms after revision with a special surface-coated TKA--a case report[J]. Acta Orthop, 2011, 82(3): 386-388.
[71]
Ajwani SH, Charalambous CP. Availability of total knee arthroplasty implants for metal hypersensitivity patients[J]. Knee Surg Relat Res, 2016, 28(4): 312-318.
[72]
Zhou K, Yu H, Li J, et al. No difference in implant survivorship and clinical outcomes between full-cementless and full-cemented fixation in primary total knee arthroplasty: a systematic review and meta-analysis[J]. Int J Surg, 2018, 53: 312-319.
[73]
Napier RJ, O′neill C, O′brien S, et al. A prospective evaluation of a largely cementless total knee arthroplasty cohort without patellar resurfacing: 10-year outcomes and survivorship[J]. BMC Musculoskelet Disord, 2018, 19(1): 205-213.
[74]
Bonamonte D, Cristaudo A, Nasorri F, et al. Efficacy of oral hyposensitization in allergic contact dermatitis caused by nickel[J]. Contact Dermatitis, 2011, 65(5): 293-301.
[75]
Aderinto J, Walmsley P, Keating JF. Fractures of the tibial spine: epidemiology and outcome[J]. Knee, 2008, 15(3): 164-167.
[1] 任俊筱, 浦路桥, 王志豪, 施洪鑫, 刘爱峰, 齐保闯, 徐永清, 李川. 机器人辅助全膝关节置换术的临床疗效对照研究[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 469-476.
[2] 许亚龙, 巩栋, 陈晓涛. 超前镇痛在全膝关节置换术中的研究进展[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 517-523.
[3] 丁莹莹, 宋恺, 金姬延, 田华. 机器人辅助膝髋关节置换术后精细化临床护理[J/OL]. 中华关节外科杂志(电子版), 2024, 18(04): 553-557.
[4] 张江礼, 刘金辉, 潘西庆, 刘光源, 范虓. 全膝关节置换应用智能辅助手术导航系统治疗膝骨关节炎[J/OL]. 中华关节外科杂志(电子版), 2024, 18(03): 346-351.
[5] 王冰, 孙海宁, 于秀淳, 周珂, 翟凯, 苗族康. 膝骨关节炎的活动衬垫型单髁置换疗效与假体生存率[J/OL]. 中华关节外科杂志(电子版), 2024, 18(03): 337-345.
[6] 杨士慷, 曹光磊. 膝骨关节炎三种术式患者满意度的术前影响因素[J/OL]. 中华关节外科杂志(电子版), 2024, 18(03): 390-397.
[7] 王啸, 李一凡, 沈素红, 曹国瑞, 史小涛, 袁彦浩, 谭红略. 全膝关节置换术后早期下肢深静脉血栓形成的时空规律[J/OL]. 中华关节外科杂志(电子版), 2024, 18(03): 414-420.
[8] 刘浩, 郑清源, 程龙, 辛鹏, 吴博, 任鹏, 张国强. 全膝关节置换术中选择窄版股骨假体的影响因素[J/OL]. 中华关节外科杂志(电子版), 2024, 18(02): 193-200.
[9] 卢芳连, 汤莉, 何河北, 李建云, 欧栓机, 陈燕, 陈娇妹. 责任护士主导的疼痛管理在膝关节置换术后的应用[J/OL]. 中华关节外科杂志(电子版), 2024, 18(02): 285-289.
[10] 赵锦伟, 李晓军, 刘桂宇, 荣晓玲, 黄明利, 宋文静, 高广凌, 鞠昌军. 固定平台假体膝关节单髁置换术中止血带应用策略研究[J/OL]. 中华关节外科杂志(电子版), 2024, 18(01): 39-47.
[11] 邓华梅, 袁札根, 曾德荣, 潘珊珊, 张葆青, 欧爱华, 曹学伟. 全膝关节置换术中气压止血带应用效果与影响因素分析[J/OL]. 中华关节外科杂志(电子版), 2023, 17(06): 788-794.
[12] 张思平, 刘伟, 马鹏程. 全膝关节置换术后下肢轻度内翻对线对疗效的影响[J/OL]. 中华关节外科杂志(电子版), 2023, 17(06): 808-817.
[13] 闫文, 谢兴文, 顾玉彪, 雷宁波, 马成, 于文霞, 高亚雄, 张磊. 微小RNA与全膝关节置换术后深静脉血栓的研究进展[J/OL]. 中华关节外科杂志(电子版), 2023, 17(06): 842-846.
[14] 王宏宇. 固定与活动平台假体在全膝关节置换术中的应用价值[J/OL]. 中华关节外科杂志(电子版), 2023, 17(06): 871-876.
[15] 李善武, 叶永杰, 王兵, 王子呓, 银毅, 孙官军, 张大刚. 胫骨高位截骨与单髁置换的早期疗效比较[J/OL]. 中华关节外科杂志(电子版), 2023, 17(06): 882-888.
阅读次数
全文


摘要


AI


AI小编
你好!我是《中华医学电子期刊资源库》AI小编,有什么可以帮您的吗?