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!

@lioness

@gardenjunkie Love the outdoors anything associated with it we had our cabin in Northern Pa my husband was a haunter,fisherman loved our Honda trailbikes it was later on we made genstone jewelry here,s a few pirces

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When it dries out I'll send off some pics of what my landscaping hobbies. Everything a soggy mess here with the entire weekly forecast showing chances of rain. No money spent on landscaping water bills this year.

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@gardeningjunkie

When it dries out I'll send off some pics of what my landscaping hobbies. Everything a soggy mess here with the entire weekly forecast showing chances of rain. No money spent on landscaping water bills this year.

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@gardenjunkie Oh good Id love to see your landscaping I had a big garden ,canned all my son was allergic to dyes,processed foods so we put in garden it's fun to plan ,buy and do right

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@debbraw

Hi @lturn9 – I am so sorry to hear about the issues you've had with your failed TKR's. I've had two TKR's and I understand that it would be devastating to find out after the fact that you had this bone cement allergy? Can I ask if you have the same orthopedic surgeon as the one who did the first ones?

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Hello, Thanks to you & others for the very kind comments! BTW, I was surprised to hear I am allergic to the cement since I am allergic to nothing else. Very frustrating. re: My ortho surgeons – TKR #1 & #2 was same surgeon, when #2 failed he referred me to a Surgeon in the same practice who specialized in Press-Fit joints, when that one failed, he referred me to a surgeon at a different practice who specializes in "Problem Knee Joints". No one has told me why the prev joints failed. I was told the 1st 2 had fractured because of my allergy. I'm not sure why the joint would fracture if the cement broke down. #4 will likely fail soon, it's been 3 years which is the longest any have lasted. Still not ready to lose my leg and will talk to another ortho surgeon for his opinion. The fun never ends. I wish you well when getting help for your knee – don't be afraid to get another opinion, but in the end there are no guarantees. BTW, I keep getting told there is only one cement available (or containing the same ingredient that I am allergic to). Take care –

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@gardeningjunkie

I truly am sorry for what you are going though. I appreciate you sharing your story about failure due to allergies, it's stories like yours that me insist to my ortho surgeon that I wanted testing for knee replacement allergies. This recently build, huge state of the art facility is on the outskirts of Springfield MO and is in Ozark MO and is a Mercy facility. They have dozens of surgeons. The appearance inside and out I compare to a luxury hotel. The architecture, furniture, even the set up of the seating areas, art and gorgeous landscaping is first class. All the equipment is shiny and modern. All they do is orthopedics.
Yet—I had to ask and insist on testing. This experienced ortho with a good record and has worked on others I know personally seemed taken aback baffled by my insistence explaining that getting the test and results would slow down the scheduling process which right now was taking 2 months to get scheduled. They are booked solid.
I wondered, "Am I the only one who ever asked for allergy testing?". They had to order in a kit and they drew the blood for me. Not sure why all that took over a month to get accomplished. I had to pay upfront for this $575.00 test and was told they didn't know if I would be reimbursed. They don't bill for this. I paid directly to the testing lab. I am having to figure this out on my own so decided to call Medicare for help which at age 70 I have never done. Medicare was surprisingly helpful with little wait time, they walked me though the steps of self billing for an expense for repayment with both of us on computers so I would know where to find the info and the form and how to fill it out and add additional information. I am in the process of working with the lab and waiting to see what happens. Of course this lab will be out of my Medicare network, but any reimbursement will help.
I truly don't understand why testing isn't required by Medicare or the doctors. I think of the misery inflicted on those with allergies.
From a purely business standpoint think of all the money Medicare will save if many like me are aware of allergies and hold off on surgery so not to be facing multiple redo's like Itrun9 and others.

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Wow! That seems like a strange attitude. When I was tested, I was referred to a allergy doc. He put a couple of dozen "spots" on my back which were 'read' a week-10 days later. I know things change, but I wonder if blood work will provide a definitive answer to whether you are allergic to the prothesis and cement, etc used during a TKR? It's been a while and my memory is not great but they may have also drawn blood (probably did). My problem is having such limited options! The part of the cement I am allergic to seems to be a part of all approved glues. I guess wrapping it with duct tape is out? 😉
re Your insurance – at the time I had BC/BS and Medicare – I didn't even have to pay a co-pay!
Good luck and stay strong!

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@lturn9

Wow! That seems like a strange attitude. When I was tested, I was referred to a allergy doc. He put a couple of dozen "spots" on my back which were 'read' a week-10 days later. I know things change, but I wonder if blood work will provide a definitive answer to whether you are allergic to the prothesis and cement, etc used during a TKR? It's been a while and my memory is not great but they may have also drawn blood (probably did). My problem is having such limited options! The part of the cement I am allergic to seems to be a part of all approved glues. I guess wrapping it with duct tape is out? 😉
re Your insurance – at the time I had BC/BS and Medicare – I didn't even have to pay a co-pay!
Good luck and stay strong!

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I will learn more when I see the ortho next month because as much as I have read about the validity of blood versus patch testing for allergies I still don't understand why my results are so different between these tests. The blood test ordered for knee replacements I had was specific to all ingredients used, like the cement, titanium, aluminum, nickle and other. It seems you were patch tested for your allergies, did you also have a blood test?
My allergist has always billed Medicare for my patch testing and since I have have the Plan F supplement I pay nothing. Simple for me. It does seem odd that this huge orthopedic hospital doesn't provide or bill directly for blood testing. I can't help but be paranoid and think they don't want to make patients aware of allergic reactions to implants.
I met a young woman (45) who is going though her 5th TKR because of rejection or failure. I couldn't face a future like that.

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I had my knee replaced for the first time almost 5 years ago. Since then I have had 4 revision surgeries. Within a year of every surgery my implant becomes loose and they have to start all over again. After the first revision surgery it was discovered that I am extremely allergic to the main ingredient in bone cement (Polymethyl methacrylate). It is constantly swollen and painful EVERY single day! In five years I have not had 1 pain free day! My last post-op appointment with my surgeon was just a couple of weeks ago and he told me "you might just have to live with it". He said there was nothing more that can be done and pretty much patted me on the back and said "good luck!". Everything that I've read says that you can NOT go from a cemented knee to none cemented knee. I know that it has been done before with success, I just can't seem to find that surgeon who has performed this procedure. If anyone knows or has any info about this I would love to hear about it!

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Hello @geraldg, and welcome to Connect. You may notice I moved your discussion and combined it with an existing discussion titled, "Need TKR and had positive allergy testing / Bone Cement and Metals." I did this so you could meet a few of the other members already discussing allergy-related issues with TKR's. Members like @okieshan1 and @doodles418, talked about their experiences with metal or cement ingredient allergies in this discussion and may have some insight on your situation as well.

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I am simply sick inside hearing your story. It could have been me. Will blog later when I have time, but have a question. If they remove the implant can they reattach the leg bones, of course without a joint it would be shorter and not bend, but then could you at least stand on it?

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@lturn9

After 2 failed TKR's (1 after 53 weeks the 2nd after 60 weeks) I was tested and told I was allergic to bone cement and that was the cause of the failure. Had a 3rd which was a press fit that lasted 3 years. I am on my 2nd (my 4th TKR) press fit which has 3 yrs on it . I would look at polymer injections, etc but it depends on the problem you have with your knee. If I had it to do over again, I would have said "No" to TKR's and waited/hoped for my knee to heel. Good luck with your knee!

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I have bone cement allergy, found after knee implant. I have had terrible problems with it not bending and now auto immune. I also have trouble taking medicines which they say the cement can be a binder. I am told only cement revisions can be done. Did You have any medicine problems with original implant? Where did you find orthopedist who would do cementless revisions? Thank you!

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@geraldg

I had my knee replaced for the first time almost 5 years ago. Since then I have had 4 revision surgeries. Within a year of every surgery my implant becomes loose and they have to start all over again. After the first revision surgery it was discovered that I am extremely allergic to the main ingredient in bone cement (Polymethyl methacrylate). It is constantly swollen and painful EVERY single day! In five years I have not had 1 pain free day! My last post-op appointment with my surgeon was just a couple of weeks ago and he told me "you might just have to live with it". He said there was nothing more that can be done and pretty much patted me on the back and said "good luck!". Everything that I've read says that you can NOT go from a cemented knee to none cemented knee. I know that it has been done before with success, I just can't seem to find that surgeon who has performed this procedure. If anyone knows or has any info about this I would love to hear about it!

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I have same problem with cement allergy but mine is 10 years of pain. No one will do cementless revision they tell me and the worry of osteoporosis. Did you find a doctor yet who could help you? I now have auto immune in legs and terrible problem taking medicines. They say the cement can be used as a binder. The meds make my knee bend less and cause awful pain around and in implant. No one seems to understand. I’m so discouraged and scared as these meds are life saving ones. Thank you for any help you can share.

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@kact

I have bone cement allergy, found after knee implant. I have had terrible problems with it not bending and now auto immune. I also have trouble taking medicines which they say the cement can be a binder. I am told only cement revisions can be done. Did You have any medicine problems with original implant? Where did you find orthopedist who would do cementless revisions? Thank you!

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I too had knee replacement and found out 5 years later I am allergic to cement. My knee could hardly bend. I have auto immune and cannot take medicines like blood pressure and antibiotics without horrible pain on side of implant and in implant. No doctor has heard of such a reaction. The allergist thought a special diet might reduce some of the inflammation I am having. This has been 10 years of pain with joint and orthos say it is sound and can’t understand my pain. It is so discouraging. I am told only cement on revisions. I wish I could find a cementless doctor. I am in Boston and have been to every hospital with no success. I was told cement is used as a binder in some medicines. I was lucky as I did not need medicines till now and they are life saving ones, but the pain is awful. The pain goes away if I stop medicines. My auto immune causes neuropathy that pulls on my implant and makes it feel like arthritis. I wear a brace to take away the pain. Your situation sounds like mine.

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I was fortunate to be tested for bone cement allergy prior to a total knee replacement and have a cement less TKR. Dr. Mark Tuttle in Denver, Colorado was my surgeon. He does revisions of TKR and uses cementless knee replacements. You can contact him at Health One Presbyterian St. Lukes's medical center. I think this number is current. 303-837-0072. Good luck!

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