Share this:
okieshan1
@okieshan1

Posts: 3
Joined: Sep 13, 2018

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

Posted by @okieshan1, Thu, Sep 13 11:20am

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!

REPLY

Here's the test results showing allergy levels.

Allergy Test Results

Okishan Im glad you are proactive on the metals and cement Im sorry to hear your problem now I dont have any answers maybe contacting Mayo they may good luck.

Hello @okieshan1. This must be a frustrating choice facing you. I did some research because I was curious myself and was able to find an article from the NIH website that you may find interesting, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4726476/. In particular, there are a few passages from the abstract of this study that you may find relevant:

"Given the limitations of current testing methods, the widespread screening of patients for metal allergies before TKA is not warranted."

"Anecdotal reports suggest that, if metal hypersensitivity is suspected and nonsurgical measures have failed, then revision to components fabricated of titanium alloy or zirconium coating can be successful in relieving symptoms. Revision should be considered as a last resort, however, and patients should be informed that no evidence-based medicine is available to guide the management of these conditions, particularly for decisions regarding revision."

@okieshan1, I see that the above mentioned alternatives also showed mildly reactive in your test results, but it does suggest that there are alternative metals and coatings out there for replacements. If you don't mind sharing, did your surgeon discuss with you any other options for knees? I would have to imagine that they have more access to resources regarding devices.

@JustinMcClanahan

Hello @okieshan1. This must be a frustrating choice facing you. I did some research because I was curious myself and was able to find an article from the NIH website that you may find interesting, https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4726476/. In particular, there are a few passages from the abstract of this study that you may find relevant:

"Given the limitations of current testing methods, the widespread screening of patients for metal allergies before TKA is not warranted."

"Anecdotal reports suggest that, if metal hypersensitivity is suspected and nonsurgical measures have failed, then revision to components fabricated of titanium alloy or zirconium coating can be successful in relieving symptoms. Revision should be considered as a last resort, however, and patients should be informed that no evidence-based medicine is available to guide the management of these conditions, particularly for decisions regarding revision."

@okieshan1, I see that the above mentioned alternatives also showed mildly reactive in your test results, but it does suggest that there are alternative metals and coatings out there for replacements. If you don't mind sharing, did your surgeon discuss with you any other options for knees? I would have to imagine that they have more access to resources regarding devices.

Jump to this post

@JustinMcClanahan to answer your question, original surgeon did suggest a coated knee to ensure no metal allergy issues. But then when he saw my bone cement allergy scores as 'Reactive' he referred me to surgeon who did cement-less knee. That 2nd surgeon sent me for an MRI for a custom built 'Biomet Vanguard Knee Replacement' which is cement-less. But then he did say there were metals in it, so suggested I hold off until I was too miserable before going for it, because he said if you do have allergy, there will be nothing I can do after the fact.

I asked does anyone make a 'coated cement-less knee' and he was not aware of one. I also asked someone in the medical supply field and they didn't have any info of that either. Do you think that is even an option? I joke and say I guess I'll have to wait until they come up with a ceramic joint.

Given your findings above, do you think my mild reaction to metal would warrant not even worrying about it?

@okieshan1

@JustinMcClanahan to answer your question, original surgeon did suggest a coated knee to ensure no metal allergy issues. But then when he saw my bone cement allergy scores as 'Reactive' he referred me to surgeon who did cement-less knee. That 2nd surgeon sent me for an MRI for a custom built 'Biomet Vanguard Knee Replacement' which is cement-less. But then he did say there were metals in it, so suggested I hold off until I was too miserable before going for it, because he said if you do have allergy, there will be nothing I can do after the fact.

I asked does anyone make a 'coated cement-less knee' and he was not aware of one. I also asked someone in the medical supply field and they didn't have any info of that either. Do you think that is even an option? I joke and say I guess I'll have to wait until they come up with a ceramic joint.

Given your findings above, do you think my mild reaction to metal would warrant not even worrying about it?

Jump to this post

I can certainly understand the concern. No one prefers surgery, and to go in with such a big question mark only makes things even more stressful. Unfortunately, I cannot answer your question about whether or not you should worry about it because I am not a medical professional and would feel horrible if I swayed your decision in any way. The evidence suggests that it is murky at best, which I imagine only makes things more grey for you. I didn't have an allergy to metal and I was also told hold off as long as you can. The pain and deformity of my knee got so bad that I woke up one day and just knew I couldn't take it anymore. Personally, on that day when things were finally so bad, I probably would have optioned to have the leg removed if given the choice.

I hope you understand I am responding with sadness to your question because I know you will not like my answer but feel you should hear from a fellow sufferer about the reality of having ACD which is your allergy to metals and cements. Also be aware in time you will become allergic to other elements and chemicals in the environment, you may already be allergic to others now, so you should have complete panels run, a good test kit is the True Test, administered by specially licensed allergists or dermatologists. Allergic Contact Dermatitis, ACD.

I started having mild issues since the age of 55, but it became the bane of my existence since age 65. Because of testing at age 66 I learned what was causing my misery, both inside and outside my skin and body, it was the 5 Day Extended Patch Test. You are having to face a difficult reality. Your allergies are an autoimmune disease and are chronic, meaning no cure, what's worse is that they are progressive and your reaction time will decrease and severity of symptoms will increase with each contact. With these allergens in or one your body it will not only affect the local area, but the histamine warriors in your bloodstream trying to battle your allergy to the cements and metals will travel through your body and poison the rest of you. I know first hand and although I wish I could give you hope, my entire body full of waring histamines causes such internal pain, stinging and inflammation I could no longer sleep because of pain and itching and was planning the cleanest and least painful way I could end my life. You cannot avoid it and your body will never adjust to your allergies.

In a few years I will be "ready" for both knees to be replaced. The cement I know I am allergic to as my testing showed, but testing did not show any allergy to metals, so far. After getting names for my allergies I have eliminated these contacts from my daily life (this is more a challenge than most can imagine). It still took over 6 months for my body to stop 99% of the ACD issues, yet now I lead a normal life, true a careful and controlled life. Few even know of my limitations and precautions. Like you my life and family life has centered around outdoor activities and yes I have had to moderate these. This is every bit as challenging as you can imagine. My motivating factors are to be free of pain and still be productive as a wife and mother and grandmother. I've succeeded, with setbacks, but life is good again. Will I have future setbacks, sure, it's the nature of this autoimmune disease.

I am no doctor but have learned mountains of information about eczema out of my will to survive and can say with certainty
if you have even a mild reaction as noted on testing you absolutely cannot consider any contact with allergic elements. Your body will never adjust and will fight this substance. I can also say with certainty you will find this depressing, but your will power can help you overcome. No one else can feel your physical or mental pain and few understand unless they also have gone or are going through this. On this site we know how you feel. You need to be a warrior. Try things that have always been 2nd choices. I just got an undated sewing machine and love the book club I joined. No more water skiing, hiking, motorcycle riding, gardening for 6 hours at a time. But I can take level walks, boat, off road with our side by side or Jeep and for gardening use a special bench that when inverted you can kneel on it and use the side legs to push yourself up since my knees are so painful. Always find a way to get outside for a few hours, it's so uplifting to the spirit and soul.

@okieshan1 I, too, have to deal with an autoimmune piece that has changed my life. My PC does not believe it so I have to fight this battle alone, except for some phone calls to Houston and Rochester and Boston. But I will be dam…..ed if I will let it whip me. I have over 100 elements to my diagnosis testing that show positive for Hereditary Gelsolin Amyloidosis, and the doc says all my testing is negative. He just does not believe Mayo, MD Anderson, or Boston. Anyway, back to us. I probably will have to start wearing an electric start and cruise control for my heart sometime soon, as mine is in Afib quite a bit now, skipping beats, PVC, Tachycardia, sawtooth 12-lead tracing. The point is, as Colin Kaepernick (whom I admire for his bravery and concern about America) says, "Just DO it!" What more can hurt you?

Have you looked into the cement less knee from Zimmer? I just signed up so I can't post a link, but the article is – FDA gives clearance zimmer biomet fully cement less knee.

@allergyone

Have you looked into the cement less knee from Zimmer? I just signed up so I can't post a link, but the article is – FDA gives clearance zimmer biomet fully cement less knee.

Jump to this post

Hi @allergyone – Thanks for great information. Oh, and welcome to Connect! Did you have the Zimmer knee replacement?

Please login or register to post a reply.