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!

My wife had revision surg with the Smith-Nephew "alloy" four years ago (strongly allergic to titanium). Vast improvement over the basic TKR joint but has deteriorated over time. Apparently the titanium ions are present. Her surgeon has suggested a possible third replacement, she can't tolerate Oxy any further so that's out of the question. Anyone else having problems with Smith-Nephew joints?

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@ardis3

Getting a knee replacement revision. Said it was highly unlikely I was allergic. Trying to get my primary doctor to get me set up with an allergy test.

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Allergy Testing- My orthopedist also said it was highly unlikely to be allergic to TKR components and I if I still wanted the test I had to pay out of pocket $600.00 up front for the blood testing for metals and bone cement used in TKR. I appealed to Medicare showing my history of allergies to many elements and these patch tests costing about $1,500 each time were paid for by Medicare. Still Medicare denied coverage of testing for TKR. The best thing I ever did for myself was pay personally for this testing before my scheduled surgery. I was allergic to 5 metals, ironically not the bone cement. I was not allergic to titanium, but it was explained to me that even titanium has many other trace metals in it which I was allergic to. I have allergies to several adhesives which are rubber or acrylic based, but not bone cement. I canceled surgery.
Even the ceramic coated implants fail to protect over time because of wear of the coating and if one has a bone cement allergy there is no benefit from a coated implant.

Side note, I know this is like playing with fire but I got the Zilretta, a time released, pelletized steroid injection in both knees 2 months ago.
Unbelieve. I still have zero pain walking up and down stairs, also if on the ground I still feel the need to roll to the front and press up with my arms for strength and balance, yet my knees aren't making me scream in pain, they feel normal, like a kid again. Medicare pays for this injection. Evidently it will do this 4 times a year. Steroids all come with side effects in the end so will put this off and perhaps treat myself to it once a year.

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Thank you. Good to know.

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To Okieshan1- I have many metal allergies like you, except not the titanium or iron, but I am also allergic to aluminum. I also had the $600 blood test. Some of mine are at the moderate level.
I just posted about the amazing results from the Zilretta injection. I am an active outdoor person, passionate about gardening and because of this injection I am free of pain while kneeling or going up or downstairs.
I had the rooster or chicken comb injections on and off for over 10 year and received no benefit lately and in the past got only 10- 20%, just maybe. The Zilretta is reported to only last 3 months, yet it's been 2 months now and still 100% free of pain.
Medicare cover this $600 injection which can be given every 3 months if needed. I assume other insurance will cover it also.
Still steroids are not meant for long term use and I plan to only treat myself to this injection once a year.

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@amandaburnett

Hi @ladytlla and welcome to Mayo Clinic Connect. I am terribly sorry to hear about your failed total knee replacements. You will see that I moved your post to a discussion that is ongoing about being allergic to the metals used for this surgery. I wanted to connect you with members who are having the same issue like @lturn9, @johnbishop, @allergyone, @kact and @ardis3

What did your doctor say about a 3rd attempt? Are you taking anything for the swelling and pain?

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Hello, following the 1st and 2nd TKR, they blamed metal allergy and a test confirmed I am allergic to the metals used in the Cement (and it seems there is only 1 bone cement), following the 3rd TKR I asked the Surgeon if they knew why the joint failed and he said he didn't know as there was no obvious reason for the failure. The joint has a mild stafh infection and as I'm sure you know it's impossible to cure an infection. The condition of my bones and my age make amputation the only option and I'm not ready for that. I have been on a maintenance level of 500mg 2x /day of Keflex. Pain at my new knee is minimal as I have Demylinating Polyneuropathy which makes both lower legs numb except to nerve pain which is very hard to control. But much of the time, my pain is very well controlled by Pregabalin and I take the max allowed which is 300mg 3X/day. If I miss a dose I have very high levels of pain. I also take a 5mg dose of oxy daily. BTW, I don't know if everyone is affected by neuropathy the same way, but if my mind is occupied with a project that requires a lot of concentration, my pain level is reduced. Hope this helps – Ask questions if you wish…

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@gardeningjunkie

Allergy Testing- My orthopedist also said it was highly unlikely to be allergic to TKR components and I if I still wanted the test I had to pay out of pocket $600.00 up front for the blood testing for metals and bone cement used in TKR. I appealed to Medicare showing my history of allergies to many elements and these patch tests costing about $1,500 each time were paid for by Medicare. Still Medicare denied coverage of testing for TKR. The best thing I ever did for myself was pay personally for this testing before my scheduled surgery. I was allergic to 5 metals, ironically not the bone cement. I was not allergic to titanium, but it was explained to me that even titanium has many other trace metals in it which I was allergic to. I have allergies to several adhesives which are rubber or acrylic based, but not bone cement. I canceled surgery.
Even the ceramic coated implants fail to protect over time because of wear of the coating and if one has a bone cement allergy there is no benefit from a coated implant.

Side note, I know this is like playing with fire but I got the Zilretta, a time released, pelletized steroid injection in both knees 2 months ago.
Unbelieve. I still have zero pain walking up and down stairs, also if on the ground I still feel the need to roll to the front and press up with my arms for strength and balance, yet my knees aren't making me scream in pain, they feel normal, like a kid again. Medicare pays for this injection. Evidently it will do this 4 times a year. Steroids all come with side effects in the end so will put this off and perhaps treat myself to it once a year.

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After having two knee replacements on my left knee, went to Mayo, talked to Dr Clarke about it and because of family history (including my mom and sisters being allergic) he replaced my third time with ceramic…have been good ever since!

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@lonna66

After having two knee replacements on my left knee, went to Mayo, talked to Dr Clarke about it and because of family history (including my mom and sisters being allergic) he replaced my third time with ceramic…have been good ever since!

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What is the name of the ceramic implant that is working for you? Did you ever have testing to determine if you have allergies to metals?

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Just found this site am I glad! I can’t get any OS to take my allergy concerns seriously. Nor can I find any allergist or fern to do this testing? I live in the Tampa area. Can anyone refer me to a testing facility willing to do this for me? Drs r no help and o e seen 4 different surgeons. One told me about a lab in Ohio but couldn’t refer me to testing person told me to see pcp but she refused saying he’s the ordering physician, it’s his job not hers. Ugh!

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@montykona2

Just found this site am I glad! I can’t get any OS to take my allergy concerns seriously. Nor can I find any allergist or fern to do this testing? I live in the Tampa area. Can anyone refer me to a testing facility willing to do this for me? Drs r no help and o e seen 4 different surgeons. One told me about a lab in Ohio but couldn’t refer me to testing person told me to see pcp but she refused saying he’s the ordering physician, it’s his job not hers. Ugh!

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I baffled as to why you can't get a doctor to prescribe testing.
My orthopedist was reluctant to have me get testing. He did tell me that the massive orthopedic hospital center in which he was only one of five surgeons did not do the testing. The center is part of a huge medical group covering our local area with every type of specialist and with a first class regional hospital, surgical centers and hundreds of doctors with offices. It also has multiple labs.
What he said I would need was not the 5 Day Extended Patch Test which had been given to me by my allergist a few years earlier, but a blood allergy test. He had to prescribe and order the test from a lab in Illinois. I had to pay in advance, Medicare doesn't cover this test. The test was ordered and the kit came to the orthopedic hospital and I believe it had to be frozen so a date was scheduled for my blood draw and then that was sent off to Chicago. It took several weeks to get the results. I wasn't surprised that I reacted to 5 metals, but was surprised I wasn't allergic to bone cement since I have other adhesive allergies.
This sounds cynical, but the only explanation I have as to why, even after I explained about my Allergic Contact Dermatitis, ACD, and positive test results to over a dozen contacts why I had to insist upon testing after he said I was ready for TKR is the Orthopedic Surgeons' have no incentive to order this test, if positive for allergens in the TKR or the cement then they don't have a patient. The ceramic coated implant he planned to use based upon my metal allergies I did my homework on and discovered a major class action lawsuit against it because the bone cement is failing to adhere to the implant. Also, even with coated implant, over time metals can escape. I am very happy the ceramic implants are working for some, but I plan to wait a few more years until desperate and make a decision based upon the history of each ceramic coated implant.

REPLY
@montykona2

Just found this site am I glad! I can’t get any OS to take my allergy concerns seriously. Nor can I find any allergist or fern to do this testing? I live in the Tampa area. Can anyone refer me to a testing facility willing to do this for me? Drs r no help and o e seen 4 different surgeons. One told me about a lab in Ohio but couldn’t refer me to testing person told me to see pcp but she refused saying he’s the ordering physician, it’s his job not hers. Ugh!

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The name of the lab my test blood was ordered from for metals and bone cement is:

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

It was not covered by Medicare or my supplement at a cost of about $600.00.

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@gardeningjunkie

I baffled as to why you can't get a doctor to prescribe testing.
My orthopedist was reluctant to have me get testing. He did tell me that the massive orthopedic hospital center in which he was only one of five surgeons did not do the testing. The center is part of a huge medical group covering our local area with every type of specialist and with a first class regional hospital, surgical centers and hundreds of doctors with offices. It also has multiple labs.
What he said I would need was not the 5 Day Extended Patch Test which had been given to me by my allergist a few years earlier, but a blood allergy test. He had to prescribe and order the test from a lab in Illinois. I had to pay in advance, Medicare doesn't cover this test. The test was ordered and the kit came to the orthopedic hospital and I believe it had to be frozen so a date was scheduled for my blood draw and then that was sent off to Chicago. It took several weeks to get the results. I wasn't surprised that I reacted to 5 metals, but was surprised I wasn't allergic to bone cement since I have other adhesive allergies.
This sounds cynical, but the only explanation I have as to why, even after I explained about my Allergic Contact Dermatitis, ACD, and positive test results to over a dozen contacts why I had to insist upon testing after he said I was ready for TKR is the Orthopedic Surgeons' have no incentive to order this test, if positive for allergens in the TKR or the cement then they don't have a patient. The ceramic coated implant he planned to use based upon my metal allergies I did my homework on and discovered a major class action lawsuit against it because the bone cement is failing to adhere to the implant. Also, even with coated implant, over time metals can escape. I am very happy the ceramic implants are working for some, but I plan to wait a few more years until desperate and make a decision based upon the history of each ceramic coated implant.

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@gardeningjunkie @montykona2 I think this is the lab in Chicago that you are speaking about.
https://www.orthopedicanalysis.com/
I had concerns and did their blood test for metal and implant allergies which was shipping in a warm blood sample so it stayed alive. I ran into resistance from a spine surgeon who would not authorize it saying it was not necessary, so I went to my GP and he authorized it. As patients we have to advocate for ourselves. One thing the test does is tell you what your immune response is right now before you are exposed to an implanted material (or for what is already in your body). That might change in time after exposure to a material and you can become allergic later even if a test had cleared you for an immune response. If you test positive, then you'll know what to avoid.

My test cleared me, and last year I broke my ankle and now have titanium plates and screws. After 6 months, I started having hives and have to stay on antihistamines. I also have some pain around the plates, so they will be removed. There are some other trace metals in the titanium, so it isn't pure, and those could be the culprits. The test was pricey, about $500, so I'm not going to repeat it now.

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@gardeningjunkie

I baffled as to why you can't get a doctor to prescribe testing.
My orthopedist was reluctant to have me get testing. He did tell me that the massive orthopedic hospital center in which he was only one of five surgeons did not do the testing. The center is part of a huge medical group covering our local area with every type of specialist and with a first class regional hospital, surgical centers and hundreds of doctors with offices. It also has multiple labs.
What he said I would need was not the 5 Day Extended Patch Test which had been given to me by my allergist a few years earlier, but a blood allergy test. He had to prescribe and order the test from a lab in Illinois. I had to pay in advance, Medicare doesn't cover this test. The test was ordered and the kit came to the orthopedic hospital and I believe it had to be frozen so a date was scheduled for my blood draw and then that was sent off to Chicago. It took several weeks to get the results. I wasn't surprised that I reacted to 5 metals, but was surprised I wasn't allergic to bone cement since I have other adhesive allergies.
This sounds cynical, but the only explanation I have as to why, even after I explained about my Allergic Contact Dermatitis, ACD, and positive test results to over a dozen contacts why I had to insist upon testing after he said I was ready for TKR is the Orthopedic Surgeons' have no incentive to order this test, if positive for allergens in the TKR or the cement then they don't have a patient. The ceramic coated implant he planned to use based upon my metal allergies I did my homework on and discovered a major class action lawsuit against it because the bone cement is failing to adhere to the implant. Also, even with coated implant, over time metals can escape. I am very happy the ceramic implants are working for some, but I plan to wait a few more years until desperate and make a decision based upon the history of each ceramic coated implant.

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I totally agree with you about no incentive to get patients tested. Gotta self advocate. I researched a lot too and don’t see a great alternative if sensitive to metal; and forget cement-less. It’s a brutal pounding deep into bone. I’m 70 + and can imagine fracturing! I would still like to find a willing Dr to coordinate an LTT blood test. I’ll keep looking and, like you, will wait a while longer for a better solution

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