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!

Hi, I'm a 66 yr F with a history of food allergies only. I am now hearing of allergies where I never did in the past. I also found out the hard way. After a TKR in '17, I had a miserable 2 years of pain, swelling and was blown off by my surgeon. I keep writing to the PA and was told it was just taking me longer to heal. The repeat XR about 5 mos after surg didn't show a problem when I asked my surgeon to see me because of swelling/pain. He said it all was normal. He knew I had many food allergies pre op but never suggested allergy testing. I wish I would have known about this potential issue and would have insisted on testing. I have eczema reaction to food as my only medical issue, but Dr's have a duty to follow up on any allergy history in this new world of now common allergies to food and environmental causes.

I was still paying for physical therapy (PT) 1 yr post op just to maintain some mobility, but it was getting harder to walk and I had to use a brace because I could now feel my knee moving. my PT recommended I get tested as she remembered a patient she had a few years back that reacted to metal in her hip replacement. I talked to the immunologist I see for the eczema and he recommenced I go to National Jewish Hospital in Denver. He contacted a Dr he knows.

I was tested, and found to have the bone cement allergy. She recommended I consult with Dr Mark Tuttle at Presbyterian St Luke hospital. He was able to do a successful revision. He said when he opened up my leg, the hardware had already come out of the tibia and the tissue looked like raw red meat from the year and a half of inflammation. I am so grateful to have found him and Dr Pacheco and am now doing well. Dr Tuttle also works with custom materials for those with metal allergies like you mention. Do contact him and let us all know how you are doing. So have hope that things will work out, be persistent.

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@coloradotkr

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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HI, see my reply below and welcome to the We Love Dr. Tuttle Club! I would love to talk with you. I'm doing well now too! Send me your text or email if you'd like to talk.

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Hi,
Good to know that you are doing well too, with a TKR by Dr. Mark Tuttle. I am in the middle of selling a house right now so no time to talk!

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@kact

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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Thank you for sharing. I’m so happy for your success.

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May I ask what test you received to confirm the allergy to cement? I have had 2 replacements in the same knee and still having issues. I do have a mild reaction to Nickel but they have not checked the cement. Curious if that was just a blood test. Have you have any additional surgeries to correct your knee? Curious…I am researching now to try and find a route for my knee as well. I am 55 year old.

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Blood allergy test by:

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

Metal-LTT Analysis Report

It tested for Bone Cement and 9 metals
I live in MO and the orthopedic center drew the blood and sent it off.
I had to pay upfront $600.00 as they explained Medicare won't pay. I paid and filed an appeal with Medicare based on my allergic history and my fear of an allergic reaction. Medicare denied my claim.

Best $600.00 I ever spent.

Payton I wish you the best in diagnosing your problem. I've decided to suffer as long as I can then go to a walker and in the end a wheel chair. I'm 71 and still active, but live with pain getting up and down, but prefer that to living with 24/7 rejection.

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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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In reply to iturn9@turn9
I too have a failed TKR from Aug.2019. I never knew that doing allergy testing “was a thing” that was available. Went full steam ahead with my surgery and realized fairly early in during rehab something was wrong! Well 13 mos post op and after seeing 5 other doctors, and a doctor who i went to see for torn rotator cuff, sent me to the last doctor, who in turn sent me for allergy testing.
Results showed I am allergic to bone cement, as well as antibiotic neomycin sulfate! Needless to say I am DEVASTATED. I need a revision, he said I need to do cement less , with no guarantee it will become stable. Someone suggested a press fit, but need to talked to knee doc about this….but you mention a polymer knee, What exactly is that and have you gone ahead with this ?
All of this must wait now, as I’m scheduled for rotator cuff surgery Jan 12, 2021. ALSO IF ANYONE HAS INFO TO SHARE RE ROTATOR SURGERY FEEL FREE TO SHARE WITH ME YOUR EXPERIENCE. Thanks, Irish283

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@irish283

In reply to iturn9@turn9
I too have a failed TKR from Aug.2019. I never knew that doing allergy testing “was a thing” that was available. Went full steam ahead with my surgery and realized fairly early in during rehab something was wrong! Well 13 mos post op and after seeing 5 other doctors, and a doctor who i went to see for torn rotator cuff, sent me to the last doctor, who in turn sent me for allergy testing.
Results showed I am allergic to bone cement, as well as antibiotic neomycin sulfate! Needless to say I am DEVASTATED. I need a revision, he said I need to do cement less , with no guarantee it will become stable. Someone suggested a press fit, but need to talked to knee doc about this….but you mention a polymer knee, What exactly is that and have you gone ahead with this ?
All of this must wait now, as I’m scheduled for rotator cuff surgery Jan 12, 2021. ALSO IF ANYONE HAS INFO TO SHARE RE ROTATOR SURGERY FEEL FREE TO SHARE WITH ME YOUR EXPERIENCE. Thanks, Irish283

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I also am allergic to antibiotic sulfates. The reaction I get is a migraine headache which will dissipate in about a half a day once internal antibiotics are discontinued. I learned the hard way as Bactrim was used after a surgery and I thought my headache was a result of the anesthesia not the anti-biotic being pumped into the IV. After hospital release and removal of IV, I was given Bactrim pills and told to take every 4 hours and wham within 10 minutes the migraine would return so I was able to figure out the cause.
As mentioned I am baffled that surgeon's and Medicare don't require allergy testing before foreign matter is inserted into our bodies. The reasons the tests are developed is because allergies exist.

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@irish283

In reply to iturn9@turn9
I too have a failed TKR from Aug.2019. I never knew that doing allergy testing “was a thing” that was available. Went full steam ahead with my surgery and realized fairly early in during rehab something was wrong! Well 13 mos post op and after seeing 5 other doctors, and a doctor who i went to see for torn rotator cuff, sent me to the last doctor, who in turn sent me for allergy testing.
Results showed I am allergic to bone cement, as well as antibiotic neomycin sulfate! Needless to say I am DEVASTATED. I need a revision, he said I need to do cement less , with no guarantee it will become stable. Someone suggested a press fit, but need to talked to knee doc about this….but you mention a polymer knee, What exactly is that and have you gone ahead with this ?
All of this must wait now, as I’m scheduled for rotator cuff surgery Jan 12, 2021. ALSO IF ANYONE HAS INFO TO SHARE RE ROTATOR SURGERY FEEL FREE TO SHARE WITH ME YOUR EXPERIENCE. Thanks, Irish283

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I would advise waiting if at all possible till Covid 19 is under control. Too risky

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I am highly allergic to silicone, especially on a large patch that was used in a heart procedure. Not only did I develop a rash at the site of the patch, but both legs had one huge rash all the way around both legs from head to toe.

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I am afraid your options are limited. I also am allergic to Bone Cement and the 1st 2 TKR's on my L leg failed because of the allergy., # 3 also failed but the reason for the failure of #3 is not known (at least to me). #4 has been in place for 3+ yrs and when it was put in place the doc had to trim a lot of bone from my femur and shin so now my leg is almost 4" shorter than the other mandating I use a walker or wheelchair everywhere I go. When #4 fails my only option will be an above-the-knee amputation. Can't tell you what a huge life style change this has been & will be. If I had known the trouble I would have, I would have learned to live with my bad knee. I have Neurpoathy in both legs and the symptom in my case has been severe pain in my lower legs. Luckily, the neuropathy has made my legs numb so I haven't had any TKR pain but the Neuropathy has more than made up for it. I know you don't need another sob story and were only looking for help with your sad situation. I wish there was something I could say to make life better for you, but all anyone can say is to tell you to take life 1 day at a time and try to make the best of things. . God Bless and Merry Christmas..

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@lturn9

I am afraid your options are limited. I also am allergic to Bone Cement and the 1st 2 TKR's on my L leg failed because of the allergy., # 3 also failed but the reason for the failure of #3 is not known (at least to me). #4 has been in place for 3+ yrs and when it was put in place the doc had to trim a lot of bone from my femur and shin so now my leg is almost 4" shorter than the other mandating I use a walker or wheelchair everywhere I go. When #4 fails my only option will be an above-the-knee amputation. Can't tell you what a huge life style change this has been & will be. If I had known the trouble I would have, I would have learned to live with my bad knee. I have Neurpoathy in both legs and the symptom in my case has been severe pain in my lower legs. Luckily, the neuropathy has made my legs numb so I haven't had any TKR pain but the Neuropathy has more than made up for it. I know you don't need another sob story and were only looking for help with your sad situation. I wish there was something I could say to make life better for you, but all anyone can say is to tell you to take life 1 day at a time and try to make the best of things. . God Bless and Merry Christmas..

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I have a severe allergy to cobalt which is in stainless steel and also a severe allergy to bone cement. Dr. Mark Tuttle in Denver Colorado does many revisions to failed surgeries involving knee replacement. He obtained a custom knee for me that did not contain cobalt or nickel. It was basically a titanium knee with another component that I don’t recall. It was cementless. I suggest that you contact as many doctors as is necessary to find the product and procedure that will work for you. I think that mine is what you would call a press in joint replacement. It is absolutely stable and the bone grows into the surface of the implant.

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