JOURNAL ARTICLE

The effect of patch testing on surgical practices and outcomes in orthopedic patients with metal implants

Natasha Atanaskova Mesinkovska, Alejandra Tellez, Luciana Molina, Golara Honari, Apra Sood, Wael Barsoum, James S Taylor
Archives of Dermatology 2012, 148 (6): 687-93
22351785

OBJECTIVE: To determine the effect of patch testing on surgical decision making and outcomes in patients evaluated for suspected metal hypersensitivity related to implants in bones or joints.

DESIGN: Medical chart review.

SETTING: Tertiary care academic medical center.

PARTICIPANTS: All patients who had patch testing for allergic contact dermatitis related to orthopedic implants.

INTERVENTION: Patch testing.

MAIN OUTCOME MEASURES: The surgeon's preoperative choice of metal implant alloy compared with patch testing results and the presence of hypersensitivity complications related to the metal implant on postsurgical follow-up.

RESULTS: Patients with potential metal hypersensitivity from implanted devices (N = 72) were divided into 2 groups depending on timing of their patch testing: preimplantation (n = 31) and postimplantation (n = 41). History of hypersensitivity to metals was a predictor of positive patch test results to metals in both groups. Positive patch test results indicating metal hypersensitivity influenced the decision-making process of the referring surgeon in all preimplantation cases (n = 21). Patients with metal hypersensitivity who received an allergen-free implant had surgical outcomes free of hypersensitivity complications (n = 21). In patients who had positive patch test results to a metal in their implant after implantation, removal of the device led to resolution of associated symptoms (6 of 10 patients).

CONCLUSIONS: The findings of this study support a role for patch testing in patients with a clinical history of metal hypersensitivity before prosthetic device implantation. The decision on whether to remove an implanted device after positive patch test results should be made on a case-by-case basis, as decided by the surgeon and patient.

Full Text Links

Find Full Text Links for this Article

Discussion

You are not logged in. Sign Up or Log In to join the discussion.

Related Papers

Remove bar
Read by QxMD icon Read
22351785
×

Save your favorite articles in one place with a free QxMD account.

×

Search Tips

Use Boolean operators: AND/OR

diabetic AND foot
diabetes OR diabetic

Exclude a word using the 'minus' sign

Virchow -triad

Use Parentheses

water AND (cup OR glass)

Add an asterisk (*) at end of a word to include word stems

Neuro* will search for Neurology, Neuroscientist, Neurological, and so on

Use quotes to search for an exact phrase

"primary prevention of cancer"
(heart or cardiac or cardio*) AND arrest -"American Heart Association"