FAQ Metal Allergies and Hip Resurfacing

Mr. McMinn
If someone is allergic to certain metal jewelry, what are the chances of having a deep tissue allergy? What is the most accurate way of testing someone for a deep tissue allergy?

It is estimated that approximately 10% of the population shows skin (cutaneous) allergy to metal products like costume jewellery. In terms of deep tissue allergy the leading authorities agree that, ‘clinically important metal hypersensitivity in patients with metal-on-metal bearings appears to be low’. In our series only 0.3% of patients required a revision for presumed metal debris reaction. It is not clear if these cases represent a true allergic response or an expected response to excess debris. There is no proven way of testing for deep tissue allergy. Cutaneous testing works through a different mechanism to deep tissue allergy, and therefore is not of much benefit. Lymphocyte transformation testing is described as one of the ways of testing potential deep tissue allergy but is not proven.

Dr. Bose
"Allergy after artificial joints is an interesting issue. One must keep in mind that the co-cr-mo alloy has been in clinical use for 45 yrs and is present in 99% of all hip and knee replacement surgery. Even if a component is titanium the articulating part would be always co-cr-mo. Therefore metal sensitivity is not exclusive to metal on metal joints. It is a factor in every joint replacement surgery and therefore has been used in millions of patients. Skin allergy is quite different from deep tissue allergy which is mediated by different mechanisms of immune response by the body. Thus skin testing is of no value when trying to gauge deep tissue hypersensitivity. There have been reports of hundreds of patients who had skin sensitivity but went on to have very successful resurfacing. Only one thing can be said about deep tissue sensitivity at this point in time — it is very very rare.

with best regards

vijay bose chennai

I have a nickel allergy and I just wanted to find out your opinion of hip resurfacing and nickel allergies?

Dr. Mont: nickel allergies are probably ok since resurfacings have minimal to no nickel but you should probably be tested for cobalt and chromium before a metal-on-metal device if one has a metal allergy

How do you determine somebody is allergic to chromium or cobalt pre op and after surgery?

Dr. Mont: Excellent question-traditional skin testing not great–there are blood tests at specialized labs. 4-5 labs will do the blood tests from around the country. The blood tests show antigenic-antibody reactions to the metals tested from the patients blood–if positive one should not get metal on metal devices in my opinion