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

Posted by okieshan1 @okieshan1, Sep 13, 2018

Does anyone have any suggestions on any medical replacement joints on the market my orthopedic surgeon might not know about? I was scheduled for total knee replacement and my surgeon MADE me take a blood allergy test from Orthopedic Analysis.. Test showed "reactive" to Bone Cement monomer so surgeon referred me to a colleague who could do a cement-less knee. Upon his review of my results however, he also stated I was "mildly-reactive" to Chromium, Molybdenum, Nickel, Vanadium, Zirconium and Iron. (Screenshot of levels attached). I'm also 'mildly reactive' to Cobalt Alloy and Titanium Alloy Particles.

My surgeon said, "I recommend you exhaust all other options, because I can do the cement-less knee, but if the metal allergy bothers you, there will be nothing I can do." Very hard to hear as I'm only 55 and active. In the meantime, I've gotten Genicular nerve burn in both knees which helped reduce pain level from 7 to a 4, but I'm trying to find out if there are any other surgical implant options that might work for someone with Bone cement and certain Metal allergies? Also, wondering will this even affect me as I can wear any type of cheap costume jewelry without ever having a reaction? If I have no issue with metal touching my skin, will it bother me if I have it in my joint for TKR?

Thanks in advance for ANY advice!

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clucky | @clucky | Jun 24, 2022
In reply to @irish283 "Hello, I had my TKR done 8/2019. I had allergy testing 14 mos.after my surgery. I..." + (show)
@irish283

Hello, I had my TKR done 8/2019. I had allergy testing 14 mos.after my surgery. I had pain and swelling and severe pain that caused me to see over 9 doctors. One doctor sent me for allergy testing for metals, glues and antibiotics. This was a back patch test. I tested positive for Neomycin sulfate and methyl methylacrolate, which is a bonding agent for the cement that is used to have your prosthetic bond with you knee and make the prosthetic steady and knee strong. I had swelling pain and the band of tightness after this surgery and unfortunately still get it. I did see one final doctor at Mt. Sinai in NYC. He had me take a very specific blood test (not covered by insurance) which checked what was going on inside my body. The first allergy test only tested for topical reactions. That’s why he had me take this other blood test. It showed I didn’t have an allergy to the cement, or any metal components. But the antibiotic used during surgery was Gentamycin, which is part of the Neomycin family. You might want to speak with Dr. Darwin Chen , he was the doctor who had me take the extensive blood test. It did give me peace of mind, knowing that I wasn’t having another knee replacement done, but was upset knowing that I was still having pain . It varies from day to day the severity, tightness, etc.
Dtr. Chen did not recommend doing a revision just because of pain.
Allergy testing at least will give you information you do not have at the moment. Good luck. @irish 283

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I thank you for sharing this information about allergy testing of knee prosthetic and cement . I am worried that I might be having an allergic reaction to my implant. I wanted to ask if you could tell me the name of the specific blood test that Dr Chen ordered. Thank you

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mrsflutterby | @mrsflutterby | Jun 25, 2022

I believe the poster was referring to the test by Orthopedic Analyses, LLC in Chicago. See https://www.orthopedicanalysis.com/order-testing-panel, specifically test #2. I have had a TKR and a Revision to the tibial component which showed no cement left on the tibial component. The doc literally lifted the prosthetic out of my leg, no chiseling. Now, 3 years later, I've got a loose prosthesis yet again. We've done blood work, a CT and I'm waiting for my Nuclear Bone Scan. If I show up with a "hot" knee again, we really have to determine why my body keeps "eating" the cement. On the revision surgery, they found a fracture in the tibial plateau on the far right side which they "built up" with cement. Now the bone and cement are gone. I have an empty spot right below the tibial plateau. This is all so scary and when I mention the concept of allergies to bone cement components or even metal parts (I know I am allergic to Nickel) I get the typical answer of "that is almost impossible or I've never heard of that being an issue". However, when I read this forum, it becomes clear to me that for some of us it is an issue. But geez, what is one suppose to do?

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1 reply
gardeningjunkie | @gardeningjunkie | Sep 7, 2022
In reply to @mrsflutterby "I believe the poster was referring to the test by Orthopedic Analyses, LLC in Chicago. See..." + (show)
@mrsflutterby

I believe the poster was referring to the test by Orthopedic Analyses, LLC in Chicago. See https://www.orthopedicanalysis.com/order-testing-panel, specifically test #2. I have had a TKR and a Revision to the tibial component which showed no cement left on the tibial component. The doc literally lifted the prosthetic out of my leg, no chiseling. Now, 3 years later, I've got a loose prosthesis yet again. We've done blood work, a CT and I'm waiting for my Nuclear Bone Scan. If I show up with a "hot" knee again, we really have to determine why my body keeps "eating" the cement. On the revision surgery, they found a fracture in the tibial plateau on the far right side which they "built up" with cement. Now the bone and cement are gone. I have an empty spot right below the tibial plateau. This is all so scary and when I mention the concept of allergies to bone cement components or even metal parts (I know I am allergic to Nickel) I get the typical answer of "that is almost impossible or I've never heard of that being an issue". However, when I read this forum, it becomes clear to me that for some of us it is an issue. But geez, what is one suppose to do?

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Please share an update on your condition.

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gardeningjunkie | @gardeningjunkie | Sep 7, 2022

To Okieshan1- please give us an update on your condition.

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heyjoe415 | @heyjoe415 | Sep 8, 2022

There should be a way to test if the metal used in the TKR causes a reaction. I would ask an allergist.

Joe

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rossc6672 | @rossc6672 | Oct 14, 2022

I’m scheduled for a partial knee replacement. Because of my knownNi allergy they were going to use the Smith and Nephew zirconium implant but now I have tested positive for Ti also. The tibial section of the implant is Ti. Is there a Ni and Ti free partial knee implant or are there new alternatives to a PKR? Are there experts in allergy or orthopedic surgery with respect to these allergies and implants? I’m in Buffalo NY. Thanks.

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3 replies
Mentor
Sue, Volunteer Mentor | @sueinmn | Oct 14, 2022
In reply to @rossc6672 "I’m scheduled for a partial knee replacement. Because of my knownNi allergy they were going to..." + (show)
@rossc6672

I’m scheduled for a partial knee replacement. Because of my knownNi allergy they were going to use the Smith and Nephew zirconium implant but now I have tested positive for Ti also. The tibial section of the implant is Ti. Is there a Ni and Ti free partial knee implant or are there new alternatives to a PKR? Are there experts in allergy or orthopedic surgery with respect to these allergies and implants? I’m in Buffalo NY. Thanks.

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There are some implants that are coated with inert materials for use in metal-sensitive patients. It will take some (maybe a lot) of research by you and your doctor to find the best one for you. My ortho docs in Minnesota are part of a large group practice, and actually have a person on staff who specializes in finding the best implants to solve these sorts of problems. Maybe your ortho does as well? The other alternative is to have him contact the Smith & Nephew rep for assistance.
Sue

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1 reply
Mentor
Jennifer, Volunteer Mentor | @jenniferhunter | Oct 14, 2022
In reply to @rossc6672 "I’m scheduled for a partial knee replacement. Because of my knownNi allergy they were going to..." + (show)
@rossc6672

I’m scheduled for a partial knee replacement. Because of my knownNi allergy they were going to use the Smith and Nephew zirconium implant but now I have tested positive for Ti also. The tibial section of the implant is Ti. Is there a Ni and Ti free partial knee implant or are there new alternatives to a PKR? Are there experts in allergy or orthopedic surgery with respect to these allergies and implants? I’m in Buffalo NY. Thanks.

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@rossc6672 One suggestion I could make is to contact the Environmental Health Center- Dallas, and I know this is confusing, but they just moved to another town, but the website is
https://www.ehcd.com/. They do treat patients for immune responses to surgical implants, and they may have information on safer choices among manufacturers.

I'm glad to hear they are using Zirconium in surgical implants. I have Zirconium dental implants, and they are fine. They are ceramic (no metal) and I have no issues. I did have issues with titanium surgical plates after breaking my ankle that caused chronic hives and pain and worsening asthma. I had them removed. The old dental work, with old crowns (titanium and other metals) were causing more phlegm in my lungs too, and I didn't know that until I was metal free when it was all removed to prep for implants and I got better, then 3 months later, I broke my ankle and got titanium. I had to give up pierced earrings too because I reacted to everything.

Titanium isn't pure. It has some other metals mixed in as an alloy. Definitely follow up on calling manufacturers.

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Mentor
John, Volunteer Mentor | @johnbishop | Oct 14, 2022
In reply to @rossc6672 "I’m scheduled for a partial knee replacement. Because of my knownNi allergy they were going to..." + (show)
@rossc6672

I’m scheduled for a partial knee replacement. Because of my knownNi allergy they were going to use the Smith and Nephew zirconium implant but now I have tested positive for Ti also. The tibial section of the implant is Ti. Is there a Ni and Ti free partial knee implant or are there new alternatives to a PKR? Are there experts in allergy or orthopedic surgery with respect to these allergies and implants? I’m in Buffalo NY. Thanks.

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Hi @rossc6672, I would like to add my welcome to Connect along with @sueinmn and others. You will notice that we moved your post into an existing discussion here so that you could meet other members who have posted about nickel, titanium and other metal allergies with knee transplants.

@mrsflutterby, @clucky, @ezas123 and others may be able to share their experience with metal allergies with you. While we wait, I did find a reference on the topic that may provide some helpful information for you.

-- PubMed – Alternative materials and solutions in total knee arthroplasty for patients with metal allergy: https://www.ncbi.nlm.nih.gov/pubmed/18210089

Have you discussed possible options with your doctor or care team?

REPLY
rossc6672 | @rossc6672 | Oct 14, 2022
In reply to @sueinmn "There are some implants that are coated with inert materials for use in metal-sensitive patients. It..." + (show)
@sueinmn

There are some implants that are coated with inert materials for use in metal-sensitive patients. It will take some (maybe a lot) of research by you and your doctor to find the best one for you. My ortho docs in Minnesota are part of a large group practice, and actually have a person on staff who specializes in finding the best implants to solve these sorts of problems. Maybe your ortho does as well? The other alternative is to have him contact the Smith & Nephew rep for assistance.
Sue

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Thanks for the reply. My orthopaedist has been running this by the S and N rep which I have been happy about.
I have since found out from my allergist that I did NOT test positive for Ti metal but titanium IV oxide which is found in cosmetics, sunscreens, paints etc. She thought I would be fine with the implant…phew! My surgery is this Wednesday so keep me in your thoughts.

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