Metal hypersensitivity in total knee arthroplasty: revision surgery using a ceramic femoral component - a case report.

Abstract

We present a case involving the revision of a total knee arthroplasty with a metal femoral component using a ceramic implant due to metal hypersensitivity. A 58-year-old female patient underwent total knee arthroplasty (TKA) with a standard metal bicondylar knee system. She suffered from persistent pain and strong limitations in her range of motion (ROM) associated with flexion during the early postoperative period. Arthroscopic arthrolysis of the knee joint and intensive active and passive physical treatment, in combination with a cortisone regime, temporarily increased the ROM and reduced pain. No signs of low grade infection or other causes of implant failure were evident. Histology of synovial tissue revealed lymphoplasmacellular fibrinous tissue, consistent with a type IV allergic reaction. Allergometry (skin reaction) revealed type IV hypersensitivity against nickel-II-sulfate and palladium chloride. Revision surgery of the metal components was performed with a cemented ceramic femoral component (same bicondylar design) and a cemented titanium alloy tibial component. Postoperative evaluations were performed 10days, and 3 and 12months after the revision surgery. There was an increased ROM in flexion to 90° at the 12month follow-up. No swelling or effusion was observed at all clinical examinations after the revision surgery. No pain at rest and moderate walking pain were evident. The presented case demonstrates that ceramic implants are a promising solution for patients suffering from hypersensitivity to metal ions in total knee arthroplasty.

• Authors: Philipp Bergschmidt, Rainer Bader, Wolfram Mittelmeier
• Journal: The Knee (Knee) Vol. 19 Issue 2 Pg. 144-7 (Mar 2012) ISSN: 1873-5800 [Electronic] Netherlands
• PMID: 21292491 (Publication Type: Case Reports, Journal Article)
• Copyright: Copyright © 2011 Elsevier B.V. All rights reserved.

Chemical References

• Metals

Topics

• Arthroplasty, Replacement, Knee (adverse effects, instrumentation)
• Cementation
• Ceramics
• Female
• Humans
• Hypersensitivity (diagnosis, etiology, immunology)
• Knee Joint (physiopathology, surgery)
• Knee Prosthesis
• Metals (adverse effects, immunology)
• Middle Aged
• Prosthesis Design
• Prosthesis Failure
• Range of Motion, Articular
• Reoperation
• Skin Tests
• Treatment Outcome