|Beitragstitel||Allergy Assessement Prior to Total Knee Replacement – Is it of Any Clinical Relevance? A Cross Sectional Study Among Swiss Orthopedic Surgeons.|
Materials used in artificial joint replacement are usually well tolerated. However, hypersensitivity to metals in particular to nickel, chromium or cobalt have been reported to cause clinical problems. One of the major difficulties in understanding the clinical implications of hypersensitivity to orthopedic implant materials is the lack of universally accepted testing methods. This study was to assess the clinical relevance of hypersensitivity to implant materials in orthopedics and the acceptance of a preoperative patch test among Swiss orthopedic surgeons in order to detect a potential allergy in patients prior to undergo knee joint replacement.
2. Material and Methods
After permission was obtained from “Swiss Orthopaedics” (Swiss Society of Orthopedic Surgeons) a secured web-based questionnaire (SurveyMonkeyTM) with an accompanying text explaining the details was sent by email to all orthopedic surgeons being members of “Swiss Orthopaedics”, excluding hand and spine surgeons.
From 642 potential participants of the web-based survey, a total of 160 filled out the questionnaire (response rate 24.9%). The majority of respondents agreed that an allergy to nickel, chromium or cobalt in patients carrying a Co/Cr/Mo prosthesis may cause a relevant clinical problem (61% nickel, 69% other metals). 113 orthopedic surgeons (70.6%) would make an allergy test before total knee replacement if there was a positive history for prosthesis-relevant allergies. Only two respondents (1.2%) would carry out an allergy test on a routine base.
This survey indicates that there is no general uniform opinion about the use of an allergy patch test for orthopedic implant materials prior of undergoing total knee replacement. Currently, patch testing is the most commonly used method for evaluating metal hypersensitivity but there is no standardized procedure. Preoperative history-taking alone appears to be insufficient for identifying patients with metal hypersensitivity. Metal hypersensitivity reactions do occur but at an unknown incidence rate and prevalence. Therefore it is emphasized that general guidelines would be required.