Need TKR and had positive allergy testing / Bone Cement and Metals

Hi @ladytlla and welcome to Mayo Clinic Connect. I am terribly sorry to hear about your failed total knee replacements. You will see that I moved your post to a discussion that is ongoing about being allergic to the metals used for this surgery. I wanted to connect you with members who are having the same issue like @lturn9, @johnbishop, @allergyone, @kact and @ardis3

What did your doctor say about a 3rd attempt? Are you taking anything for the swelling and pain?

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Allergy Testing- My orthopedist also said it was highly unlikely to be allergic to TKR components and I if I still wanted the test I had to pay out of pocket $600.00 up front for the blood testing for metals and bone cement used in TKR. I appealed to Medicare showing my history of allergies to many elements and these patch tests costing about $1,500 each time were paid for by Medicare. Still Medicare denied coverage of testing for TKR. The best thing I ever did for myself was pay personally for this testing before my scheduled surgery. I was allergic to 5 metals, ironically not the bone cement. I was not allergic to titanium, but it was explained to me that even titanium has many other trace metals in it which I was allergic to. I have allergies to several adhesives which are rubber or acrylic based, but not bone cement. I canceled surgery.
Even the ceramic coated implants fail to protect over time because of wear of the coating and if one has a bone cement allergy there is no benefit from a coated implant.

Side note, I know this is like playing with fire but I got the Zilretta, a time released, pelletized steroid injection in both knees 2 months ago.
Unbelieve. I still have zero pain walking up and down stairs, also if on the ground I still feel the need to roll to the front and press up with my arms for strength and balance, yet my knees aren't making me scream in pain, they feel normal, like a kid again. Medicare pays for this injection. Evidently it will do this 4 times a year. Steroids all come with side effects in the end so will put this off and perhaps treat myself to it once a year.

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After having two knee replacements on my left knee, went to Mayo, talked to Dr Clarke about it and because of family history (including my mom and sisters being allergic) he replaced my third time with ceramic…have been good ever since!

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Just found this site am I glad! I can’t get any OS to take my allergy concerns seriously. Nor can I find any allergist or fern to do this testing? I live in the Tampa area. Can anyone refer me to a testing facility willing to do this for me? Drs r no help and o e seen 4 different surgeons. One told me about a lab in Ohio but couldn’t refer me to testing person told me to see pcp but she refused saying he’s the ordering physician, it’s his job not hers. Ugh!

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Just found this site am I glad! I can’t get any OS to take my allergy concerns seriously. Nor can I find any allergist or fern to do this testing? I live in the Tampa area. Can anyone refer me to a testing facility willing to do this for me? Drs r no help and o e seen 4 different surgeons. One told me about a lab in Ohio but couldn’t refer me to testing person told me to see pcp but she refused saying he’s the ordering physician, it’s his job not hers. Ugh!

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I baffled as to why you can't get a doctor to prescribe testing.
My orthopedist was reluctant to have me get testing. He did tell me that the massive orthopedic hospital center in which he was only one of five surgeons did not do the testing. The center is part of a huge medical group covering our local area with every type of specialist and with a first class regional hospital, surgical centers and hundreds of doctors with offices. It also has multiple labs.
What he said I would need was not the 5 Day Extended Patch Test which had been given to me by my allergist a few years earlier, but a blood allergy test. He had to prescribe and order the test from a lab in Illinois. I had to pay in advance, Medicare doesn't cover this test. The test was ordered and the kit came to the orthopedic hospital and I believe it had to be frozen so a date was scheduled for my blood draw and then that was sent off to Chicago. It took several weeks to get the results. I wasn't surprised that I reacted to 5 metals, but was surprised I wasn't allergic to bone cement since I have other adhesive allergies.
This sounds cynical, but the only explanation I have as to why, even after I explained about my Allergic Contact Dermatitis, ACD, and positive test results to over a dozen contacts why I had to insist upon testing after he said I was ready for TKR is the Orthopedic Surgeons' have no incentive to order this test, if positive for allergens in the TKR or the cement then they don't have a patient. The ceramic coated implant he planned to use based upon my metal allergies I did my homework on and discovered a major class action lawsuit against it because the bone cement is failing to adhere to the implant. Also, even with coated implant, over time metals can escape. I am very happy the ceramic implants are working for some, but I plan to wait a few more years until desperate and make a decision based upon the history of each ceramic coated implant.

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I baffled as to why you can't get a doctor to prescribe testing.
My orthopedist was reluctant to have me get testing. He did tell me that the massive orthopedic hospital center in which he was only one of five surgeons did not do the testing. The center is part of a huge medical group covering our local area with every type of specialist and with a first class regional hospital, surgical centers and hundreds of doctors with offices. It also has multiple labs.
What he said I would need was not the 5 Day Extended Patch Test which had been given to me by my allergist a few years earlier, but a blood allergy test. He had to prescribe and order the test from a lab in Illinois. I had to pay in advance, Medicare doesn't cover this test. The test was ordered and the kit came to the orthopedic hospital and I believe it had to be frozen so a date was scheduled for my blood draw and then that was sent off to Chicago. It took several weeks to get the results. I wasn't surprised that I reacted to 5 metals, but was surprised I wasn't allergic to bone cement since I have other adhesive allergies.
This sounds cynical, but the only explanation I have as to why, even after I explained about my Allergic Contact Dermatitis, ACD, and positive test results to over a dozen contacts why I had to insist upon testing after he said I was ready for TKR is the Orthopedic Surgeons' have no incentive to order this test, if positive for allergens in the TKR or the cement then they don't have a patient. The ceramic coated implant he planned to use based upon my metal allergies I did my homework on and discovered a major class action lawsuit against it because the bone cement is failing to adhere to the implant. Also, even with coated implant, over time metals can escape. I am very happy the ceramic implants are working for some, but I plan to wait a few more years until desperate and make a decision based upon the history of each ceramic coated implant.

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The name of the lab my test blood was ordered from for metals and bone cement is:

Orthopedic Analysis
2201 W. Campbell Park Drive
Ste 215
Chicago, IL 60612
http://www.orthopedicanalysis.com

It was not covered by Medicare or my supplement at a cost of about $600.00.

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@gardeningjunkie @montykona2 I think this is the lab in Chicago that you are speaking about.
https://www.orthopedicanalysis.com/

I had concerns and did their blood test for metal and implant allergies which was shipping in a warm blood sample so it stayed alive. I ran into resistance from a spine surgeon who would not authorize it saying it was not necessary, so I went to my GP and he authorized it. As patients we have to advocate for ourselves. One thing the test does is tell you what your immune response is right now before you are exposed to an implanted material (or for what is already in your body). That might change in time after exposure to a material and you can become allergic later even if a test had cleared you for an immune response. If you test positive, then you'll know what to avoid.

My test cleared me, and last year I broke my ankle and now have titanium plates and screws. After 6 months, I started having hives and have to stay on antihistamines. I also have some pain around the plates, so they will be removed. There are some other trace metals in the titanium, so it isn't pure, and those could be the culprits. The test was pricey, about $500, so I'm not going to repeat it now.

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