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!

@gardeningjunkie

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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Thank you!

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@jenniferhunter

@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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Like you I am not allergic to titanium, but my ortho did say just what you did, that there are trace metals in titanium. I'm sorry about you are getting hives and although I have eczema I don't have hives. Can they do testing for hives like they do for eczema?
I also believe constant contact of a foreign object in or outside of our bodies can lead to allergies. What's in titanium probably is raising your histamine army trying to get rid of the titanium. At least you can have the plates removed if you have healed. I didn't get Allergic Contact Dermatitis until middle age. Our body, in time, believes these foreign substances are dangerous invaders and raise up our histamine armies to purge the rejected substance causing eczema and I am assuming hives also. I do believe I would have been a good prairie wife from a century ago- making my own soap from lye and lard without preservatives, wearing 100% cotton clothing, cleaning with natural products like vinegar and so on. I am free of all 3 types of my eczema today because of diligent research and blogging on several sites. We learn from each other.

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@gardeningjunkie

Like you I am not allergic to titanium, but my ortho did say just what you did, that there are trace metals in titanium. I'm sorry about you are getting hives and although I have eczema I don't have hives. Can they do testing for hives like they do for eczema?
I also believe constant contact of a foreign object in or outside of our bodies can lead to allergies. What's in titanium probably is raising your histamine army trying to get rid of the titanium. At least you can have the plates removed if you have healed. I didn't get Allergic Contact Dermatitis until middle age. Our body, in time, believes these foreign substances are dangerous invaders and raise up our histamine armies to purge the rejected substance causing eczema and I am assuming hives also. I do believe I would have been a good prairie wife from a century ago- making my own soap from lye and lard without preservatives, wearing 100% cotton clothing, cleaning with natural products like vinegar and so on. I am free of all 3 types of my eczema today because of diligent research and blogging on several sites. We learn from each other.

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@gardeningjunkie Thank you! I like thinking about history and living during past historical periods too, and then I think about how much medicine has learned since then. I would have died from an infection when I was 9 years old without antibiotics. I'm sure I can't be allergy tested now for anything because of being on antihistamines and I would be miserable if I stopped taking them. I wish we knew what was causing my husband's ezcema. He seems to think is is an uncurable type. Can you share the blogs you were following on that?

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@jenniferhunter

@gardeningjunkie Thank you! I like thinking about history and living during past historical periods too, and then I think about how much medicine has learned since then. I would have died from an infection when I was 9 years old without antibiotics. I'm sure I can't be allergy tested now for anything because of being on antihistamines and I would be miserable if I stopped taking them. I wish we knew what was causing my husband's ezcema. He seems to think is is an uncurable type. Can you share the blogs you were following on that?

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Jennifer, like you, my husband would have died as a child from a ruptured appendix and yes modern medicine is lifesaving, yet it's all the other modern contacts that are causing diseases.
Get ready, I have written a novel.
What is the name of his type.? Saying he has eczema is like saying he has cancer, what type he has is necessary to know to treat it.
I blog on the Mayo site about Grover's Disease, GD, aka, Transient Acantholytic Dermatitis. Dermatitis and eczema are synonymous. It's considered a rare form with no know treatment, if you follow the Mayo blog it doesn't seem rare, there are plenty of us. I blog on the Inspire site about my Allergic Contact Dermatitis, ACD and Perioral Eczema, PE. For ACD the amazing 5 Day Extended Patch Test identified my allergens to avoid and gave me my life back, avoidance is the key, steroids are for temporary break outs, however with avoidance steroids should not be needed for most people.
All eczema is incurable, yet some types are more treatable then others. From all my blogging over the years there are two forms, which I do not have, that seem the most difficult to treat- Atopic, AE and Dysidrotic, DE. Both these forms are confounding and AE is a heartbreaker because many are born with it. The poor babies suffer and nothing can be done. Their hands are wrapped to keep them from scratching. Yet, AE has a new miracle drug, Dupixent to treat it but it is not for babies. Dysidrotic is a scaly, flaking, peeling form which targets the feet and hands. The affected areas crack and bleed. Most with DE itch but my son has this form which he developed in his 30's and he is lucky he doesn't get much itching. About all that can be done is keep a barrier, heavy ointment on and the doctors prescribe the evil steroids, yet steroids do help outbreaks, still the price is paid down the road with side effects.
I am free of all my 3 forms and the Mayo GD site is a godsend. I learned about cilantro smoothies from a posting by Kimass1 in late Feb of 2019. I consider her my guardian angel, my life was so limited with my recurring GD outbreaks. The theory she shared, which unfortunately derms do not tell us about is how heavy metals are tied to Parkinson's, Alzheimer's and GD. Cilantro is a natural heavy metal detox, no need to get your blood chelated to remove heavy metals. We on the Mayo GD became human Guinea Pigs and tried this theory and about 50% of us went into remission, I was one of the lucky ones. I am still clear to this day as well as are many others. I learned how to correctly identify my Perioral Eczema, PE on the Inspire site because a blogger mentioned the specific location of her rash and named its type. It sounded just like a fairly new rash area I had for months. My doctors were treating it as if it were my ACD with steroids- ironically steroids trigger PE. Perioral should be easy to diagnose because the rash is around the mouth and can be around the eyes also. Still my derm got it wrong. Many of us with eczema have several types, but doctors often keep thinking it is the original type you were diagnosed with. The New Zealand skin site photos were helpful because I was looking at rashes like mine.
I am free of all 3 forms today.
If your husband doesn't know his type the best site I have ever found is dermnetnz.org. This New Zealand site has a complete list all the eczema types (if you search on the Mayo site they don't even mention two of my types). Best of all they have dozens of photos of patients with each type. Seeing the shape and location of the rash is helpful in identification. They also give a brief written description.
All said, in spite of all I have written about most types benefit from an anti-inflammation diet. Even with avoidance of all my allergic allergens identified in testing I still had severe internal inflammation inside my skin and I was at the point of suicide because of the burning, stinging, itching and lack of sleep. A cortico-steroid shot helped for about 10 months, Kenalog 40. It is a potent drug. Changing my diet, basically giving up processed sugar, limiting natural sugar and limiting carbs completely eliminated my need for this shot. I haven't had it now for 2 1/2 years. I no longer have the internal skin misery at all. The plan I strictly followed during my 2-3 month detox and now only follow the maintenance program is the William Crooke, MD, The Yeast Connection Handbook. He ties the living yeast in our bodies, which we all have, to various diseases. I didn't have classic yeast symptoms on my outside so never though about what yeast is doing on our insides. He explains it in laymen's terms, very helpful simply hand drawn diagrams. The yeast waste which we all have inside our bloodstream which is trying to clear it out raises our histamine army leading to inflammation. The detox period is brutal, but that's because the yeast is dying from lack of sugar and screaming at your brain for the foods that will keep it alive. I was desperate and in so much pain I was motivated to try this diet. It's not limiting in calories, but it is much like the Keto diet, the lack of sugars and carbs leaves you craving constantly. Surprisingly I no longer think about foods with processed sugar at all. That craving will leave once the yeast colonies die out.

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I have been diagnosed as needing a second revision surgery after the first two femoral prosthesis loosened. In each case the problems were diagnosed at the three year follow-up but the symptoms of pain, swelling and poor range of motion had existed long before that. Before the initial revision surgery the implant was loosening from the lateral condyle. This time it Is loosening from both condyles. Is there a surgical technique that involves additional methods to attach the implant beyond the cementing and the "rod" that was attached during my distribution procedure?

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@sralph

I have been diagnosed as needing a second revision surgery after the first two femoral prosthesis loosened. In each case the problems were diagnosed at the three year follow-up but the symptoms of pain, swelling and poor range of motion had existed long before that. Before the initial revision surgery the implant was loosening from the lateral condyle. This time it Is loosening from both condyles. Is there a surgical technique that involves additional methods to attach the implant beyond the cementing and the "rod" that was attached during my distribution procedure?

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Sorry, the last sentence should read: Is there a surgical technique, other than cementless surgery, that involves additional methods to attach the implant other than the "stem" that was attached during my previous revision procedure?

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@sralph

Sorry, the last sentence should read: Is there a surgical technique, other than cementless surgery, that involves additional methods to attach the implant other than the "stem" that was attached during my previous revision procedure?

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Hello, and welcome to Mayo Connect. We are a community of people living with a variety of health conditions and diseases, who try to help and support each other on our journeys. We are not doctors, so we cannot give medical advice, but we can share our experiences. I have not had my knee replaced, but had multiple hip replacement surgeries due to metallosis from the first implants used.

In your situation, after 2 unsuccessful implants and your desire for a new alternative, you might want to contact a larger multidisciplinary facility like May Clinics or a University hospital near you to discuss newer options. You could also search on line for "new techniques in knee replacement" or similar, and just follow where it leads, concentrating on articles published by NIH, or Orthopedic professional groups.

Does this give you a starting point?
Sue

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@sueinmn

Hello, and welcome to Mayo Connect. We are a community of people living with a variety of health conditions and diseases, who try to help and support each other on our journeys. We are not doctors, so we cannot give medical advice, but we can share our experiences. I have not had my knee replaced, but had multiple hip replacement surgeries due to metallosis from the first implants used.

In your situation, after 2 unsuccessful implants and your desire for a new alternative, you might want to contact a larger multidisciplinary facility like May Clinics or a University hospital near you to discuss newer options. You could also search on line for "new techniques in knee replacement" or similar, and just follow where it leads, concentrating on articles published by NIH, or Orthopedic professional groups.

Does this give you a starting point?
Sue

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Sue, thanks for your thoughtful reply. I have been doing the research you suggested. In fact that is how I learned about this forum. My hope in posting here was there might be member(s) who have had personal experience with an alternative method.

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@sralph

Sue, thanks for your thoughtful reply. I have been doing the research you suggested. In fact that is how I learned about this forum. My hope in posting here was there might be member(s) who have had personal experience with an alternative method.

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Let's hope someone chimes in with their experience! I wish Connect had been available when my first hip implant rejected – I would certainly have taken a different approach and gotten a better result. As it was, I let my laissez-faire ortho minimize what I was suffering, and was very ill for months, unnecessarily.
Sue

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