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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@rossc6672

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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@rossc6672 I wanted to let you know that I did a blood test from Orthopedic Analysis in Chicago that tested for immune responses to surgical implants, and I wasn't allergic to anything. That was before I had spine surgery, and I opted anyway for a fusion with no hardware. When I broke my ankle, I got titanium plates and started getting hives 6 months later with large masses of hives that went on for months. I had to stay on antihistamines at least every third day, or I couldn't stand the itching. I had large welts fusing together in big patches. I had to wait at least a year before I could have the plates removed, and when I did that, the hives stopped and my asthma improved. You can develop an allergy or immune response later, after a period of exposure to a material. That would be a question to ask your surgeon. Maybe no one has an answer as to what the risk would be for that happening later down the road, and then what do you do? The Environmental Health Center- Dallas does treat patients in that predicament. It may involve also treating allergies for everything that bothers you to lessen the total load on your body. I sure will hope for the best for you.

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I had a hip replacement back on ‘04. I was 41 yrs old w/ a 2 yr old at home & pregnant/ my 2nd. They scheduled a c-section & 6 weeks after, I had my hip replaced. It was metal on metal. I too was quite active (until the last part of 2nd pregnancy). I had AVN, of which I had no idea until I could barely walk w/ all the pregnancy weight gain. I was not over weight for my size…when I was pregnant, no diabetes…I was healthy. 16 years later, I had what basically was a “pocket” of metal ions that burst & flooded my body. It was really indescribable. It was like having dementia..(I realize in hindsight). When I could finally get out of bed, we went straight to an orthopedic surgeon who tested me for metal, which of course was positive. I never knew there was such a thing. I was so sick before the revision (mentally) & otherwise. I say to you now, from an orthopedic surgeon’s mouth…if you have metal in your body, it comes with the territory…so to speak…
I would go as long as you possibly can before having an implant. I wish I had been tested before I had mine, not sure what else I could’ve done, but maybe be tested for metal or concrete every few months or so. Even then, I don’t know what options there are. I had my rev 16 years after 1st implant.
Good luck!

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@sickofbeinsick1

I had a hip replacement back on ‘04. I was 41 yrs old w/ a 2 yr old at home & pregnant/ my 2nd. They scheduled a c-section & 6 weeks after, I had my hip replaced. It was metal on metal. I too was quite active (until the last part of 2nd pregnancy). I had AVN, of which I had no idea until I could barely walk w/ all the pregnancy weight gain. I was not over weight for my size…when I was pregnant, no diabetes…I was healthy. 16 years later, I had what basically was a “pocket” of metal ions that burst & flooded my body. It was really indescribable. It was like having dementia..(I realize in hindsight). When I could finally get out of bed, we went straight to an orthopedic surgeon who tested me for metal, which of course was positive. I never knew there was such a thing. I was so sick before the revision (mentally) & otherwise. I say to you now, from an orthopedic surgeon’s mouth…if you have metal in your body, it comes with the territory…so to speak…
I would go as long as you possibly can before having an implant. I wish I had been tested before I had mine, not sure what else I could’ve done, but maybe be tested for metal or concrete every few months or so. Even then, I don’t know what options there are. I had my rev 16 years after 1st implant.
Good luck!

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I don't know for sure, but it may be that they replaced the top of your femur AND lined the pelvic socket with metal. Metal rubbing on metal will shed ions. THRs and TKRs these days are done with metal on polyethylene (plastic) prosthesis. In the case of a THR, the socket is smoothed out and then a polyethylene liner is put in place.

I can't be sure, but if you are metal on metal, it's probably time for a revision.

(I had both knees replaced and they use polyethylene spacers where the menisci were. So no metal on metal. and my surgeon used the Mako robotic assistant.))

All the best to you.

Joe

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@okieshan1

Here's the test results showing allergy levels.

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I had 4 metal allergies & bone cement but nickel was highly reactive, I had Conformis TKR in 2019 and I was told I was better off living with it than to do revision. I had TKR in left knee 2 weeks ago (OCT 12 2022) and Dr used Smith-Nephew (oxidized zirconium) but had to use bone cement. I could have used cement-less, but my first TKR is ok, just stiff all the time. I'd rather deal with bone cement than 4 metal allergies. You are mildly reactive, you might want to live with it, alot of revisions get infections. Just my opinion! Good luck!!!

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@denhyg1run

I had 4 metal allergies & bone cement but nickel was highly reactive, I had Conformis TKR in 2019 and I was told I was better off living with it than to do revision. I had TKR in left knee 2 weeks ago (OCT 12 2022) and Dr used Smith-Nephew (oxidized zirconium) but had to use bone cement. I could have used cement-less, but my first TKR is ok, just stiff all the time. I'd rather deal with bone cement than 4 metal allergies. You are mildly reactive, you might want to live with it, alot of revisions get infections. Just my opinion! Good luck!!!

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also, I was very active, 3 Ironman's in my 60's, many triathlon and marathons, now i bike with assist, and walk & swim, I just have to be outside!

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@denhyg1run

I had 4 metal allergies & bone cement but nickel was highly reactive, I had Conformis TKR in 2019 and I was told I was better off living with it than to do revision. I had TKR in left knee 2 weeks ago (OCT 12 2022) and Dr used Smith-Nephew (oxidized zirconium) but had to use bone cement. I could have used cement-less, but my first TKR is ok, just stiff all the time. I'd rather deal with bone cement than 4 metal allergies. You are mildly reactive, you might want to live with it, alot of revisions get infections. Just my opinion! Good luck!!!

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sorry, i just realized you haven't had TKR yet, oxidized zirconium is an option, Smith-Nephew, or Stryker titanium, if you're not allergic. I've been living with bone cement allergy & so far so good but it's still s worry. At least your Dr recommended allergy test, I asked before surgery about allergies and my Dr said "1 in a million" well, that is certainly not true.

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@skeleton

Can’t wait to read your next after visit post. I am full of metal, rods, plates, pins, stainless steel cable ties. You are awesome to share this. I have often thought my legs do not match in length after 3 femur breaks. 🙏🙏🙏💕💕💕💕

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Hello Skeleton this is Irish 283 with the continuing saga of my failure of the original TKR from 8/2019….well Dr.#11 and I agreed on a course of action. Last Tuesday 10/18 I had a minimally invasive procedure….after looking at the last MRI the Dr.said he would remove spacer from my knee and put in a NEW REPLACEMENT SPACER WHICH IS BIGGER. He felt this would definitely help stabilize my knee and my MCL did not have any tears at all. While replacing the spacer, my dr, noticed that the original spacer was way too small and implanted incorrectly! He also felt that the Methylmethylacrylate (sp?) also played a part in my pain and discomfort. He felt it made my scar tissue even thicker to deal with for removing it from my knee.
I am only ONE WEEK post op so don’t have too much to say….yes it hurts, yes it’s swollen, yes it’s warm to touch. He did go through the original site. I go for first PT examination on Thursday, Oct.27, and again on 10/31. See Dr. For post op on 11/2. I am using a walker for now and trying to get extension….I do use cryocuff throughout day and night.
Sooooo my story continues….
I will keep in touch…..

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@irish283

Hello Skeleton this is Irish 283 with the continuing saga of my failure of the original TKR from 8/2019….well Dr.#11 and I agreed on a course of action. Last Tuesday 10/18 I had a minimally invasive procedure….after looking at the last MRI the Dr.said he would remove spacer from my knee and put in a NEW REPLACEMENT SPACER WHICH IS BIGGER. He felt this would definitely help stabilize my knee and my MCL did not have any tears at all. While replacing the spacer, my dr, noticed that the original spacer was way too small and implanted incorrectly! He also felt that the Methylmethylacrylate (sp?) also played a part in my pain and discomfort. He felt it made my scar tissue even thicker to deal with for removing it from my knee.
I am only ONE WEEK post op so don’t have too much to say….yes it hurts, yes it’s swollen, yes it’s warm to touch. He did go through the original site. I go for first PT examination on Thursday, Oct.27, and again on 10/31. See Dr. For post op on 11/2. I am using a walker for now and trying to get extension….I do use cryocuff throughout day and night.
Sooooo my story continues….
I will keep in touch…..

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Sorry Irish,

Please make sure to stick with the ROM exercises and later strength exercises for the knee. Gotta be on top of that and I'm sure you are. Putting in the wrong-sized spacer sounds like malpractice to me.

My surgeon used Stryker prosthesis and the Mako robot. Both TKRs went well.

All the best to you friend.

Joe

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@sickofbeinsick1

I had a hip replacement back on ‘04. I was 41 yrs old w/ a 2 yr old at home & pregnant/ my 2nd. They scheduled a c-section & 6 weeks after, I had my hip replaced. It was metal on metal. I too was quite active (until the last part of 2nd pregnancy). I had AVN, of which I had no idea until I could barely walk w/ all the pregnancy weight gain. I was not over weight for my size…when I was pregnant, no diabetes…I was healthy. 16 years later, I had what basically was a “pocket” of metal ions that burst & flooded my body. It was really indescribable. It was like having dementia..(I realize in hindsight). When I could finally get out of bed, we went straight to an orthopedic surgeon who tested me for metal, which of course was positive. I never knew there was such a thing. I was so sick before the revision (mentally) & otherwise. I say to you now, from an orthopedic surgeon’s mouth…if you have metal in your body, it comes with the territory…so to speak…
I would go as long as you possibly can before having an implant. I wish I had been tested before I had mine, not sure what else I could’ve done, but maybe be tested for metal or concrete every few months or so. Even then, I don’t know what options there are. I had my rev 16 years after 1st implant.
Good luck!

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I forgot to say, to this day my emotional state is shakey to say the least…but the pain in my gut is ABSOLUTELY UNBEARABLY. It’s not constant, but BAD days FAR outweigh the bearable ones.
Still can’t wear anything on my waist…& let me tell you, I NEED clothes ! So frustrating.
Life’s not near as fun…not sure how long I can go on like this. I used to be fun, outgoing…can’t remember the last time I was happy. EXISTING w/ pain is NOT living

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@heyjoe415

I don't know for sure, but it may be that they replaced the top of your femur AND lined the pelvic socket with metal. Metal rubbing on metal will shed ions. THRs and TKRs these days are done with metal on polyethylene (plastic) prosthesis. In the case of a THR, the socket is smoothed out and then a polyethylene liner is put in place.

I can't be sure, but if you are metal on metal, it's probably time for a revision.

(I had both knees replaced and they use polyethylene spacers where the menisci were. So no metal on metal. and my surgeon used the Mako robotic assistant.))

All the best to you.

Joe

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My 1st hip was MoM. Had rev. in ‘20..only 16 yrs later..the new does have ceramic or what ever, but still hurts like hades. I can’t wait til my rite hip gives (AVN) in that 1 as well
😩

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