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!

Interested in more discussions like this? Go to the Joint Replacements group.

Well had knee replacement and knee swells all the time and I have a constant rash on my knee. Wonder if its a allergy to implant if there is anything I can do to alleviate the issue?

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@mscan7

Well had knee replacement and knee swells all the time and I have a constant rash on my knee. Wonder if its a allergy to implant if there is anything I can do to alleviate the issue?

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Welcome @mscan7, That would be a great question to ask your surgeon or care team. Here's some information on the question — "Can knee replacement cause a rash? — Hypersensitivity Reactions — There are two reactions that seem to occur in patients who have metal hypersensitivity to a knee replacement implant. The first is a skin reaction called dermatitis. In this condition, a skin rash that looks like eczema can occur." — Sensitivity to the Metal Parts in a Knee Replacement: https://www.verywellhealth.com/sensitivity-and-allergy-to-metals-in-knee-replacement-4082730

Have you discussed the swelling and rash on your knee with your surgeon or care team?

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Your question interest me not because I have allergies but the point will surgery make it better…… my tkr did not make life better…..I thought with tkr I would be like most back on my feet in few weeks …..did not cross my mind that seven months later I be still struggling to get normalcy back to my life…. But here I am one of the negative story I read on my dr reviews that he gave up on few e weeks in….I am telling you this you say you are active if you are still doing a lot of what you enjoy doing …. Although I know you might have some pain but do anyway that is awesome….. I am 58 I could not do a lot of what I like to do so tkr for me was last result ….. they say my other knee needs to be done I will never do this again….everything I have learned about myself and my body …..my body builds scar tissue very quickly that has been constant issue ….,if I knew this before hand would I have done surgery not sure I think I just wanted pain to be gone all the time ….. but unfortunately that did not happen for me ….. what I am saying look at both sides because it can be worse than it is right now……. Just some food for thought good luck in whatever you do

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@johnbishop

Welcome @mscan7, That would be a great question to ask your surgeon or care team. Here's some information on the question — "Can knee replacement cause a rash? — Hypersensitivity Reactions — There are two reactions that seem to occur in patients who have metal hypersensitivity to a knee replacement implant. The first is a skin reaction called dermatitis. In this condition, a skin rash that looks like eczema can occur." — Sensitivity to the Metal Parts in a Knee Replacement: https://www.verywellhealth.com/sensitivity-and-allergy-to-metals-in-knee-replacement-4082730

Have you discussed the swelling and rash on your knee with your surgeon or care team?

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@mscan7 This is a link to a practice in Texas that pioneered the field of Environmental Medicine. They do treat people with immune responses to surgical implant materials. https://www.ehcd.com/implant-services

If you wish to search for another provider in this field, there is a search at https://www.aaemonline.org/

While I have not had a knee replacement, I have had my health affected by materials from dentistry and titanium surgical plates after an ankle fracture. My health and allergic asthma improved after all of the various metals were removed from my body and during the time I had the titanium plates, I had chronic hives. I had the plates removed 6 months ago. I also have multiple allergies and food allergies. Some of that has improved too since the metals are gone. I realize that having a knee replacement is a different issue and it can't just be removed, but in my experience this does give validation to how foreign materials can cause an immune response. It seems that all these sensitivities and allergies just keep adding to the problem, and if you can reduce the immune response in some other areas, the body can handle everything a bit better.

Are you familiar with Environmental Medicine?

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@mscan7

Well had knee replacement and knee swells all the time and I have a constant rash on my knee. Wonder if its a allergy to implant if there is anything I can do to alleviate the issue?

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Hello, I had my TKR done 8/2019. I had allergy testing 14 mos.after my surgery. I had pain and swelling and severe pain that caused me to see over 9 doctors. One doctor sent me for allergy testing for metals, glues and antibiotics. This was a back patch test. I tested positive for Neomycin sulfate and methyl methylacrolate, which is a bonding agent for the cement that is used to have your prosthetic bond with you knee and make the prosthetic steady and knee strong. I had swelling pain and the band of tightness after this surgery and unfortunately still get it. I did see one final doctor at Mt. Sinai in NYC. He had me take a very specific blood test (not covered by insurance) which checked what was going on inside my body. The first allergy test only tested for topical reactions. That’s why he had me take this other blood test. It showed I didn’t have an allergy to the cement, or any metal components. But the antibiotic used during surgery was Gentamycin, which is part of the Neomycin family. You might want to speak with Dr. Darwin Chen , he was the doctor who had me take the extensive blood test. It did give me peace of mind, knowing that I wasn’t having another knee replacement done, but was upset knowing that I was still having pain . It varies from day to day the severity, tightness, etc.
Dtr. Chen did not recommend doing a revision just because of pain.
Allergy testing at least will give you information you do not have at the moment. Good luck. @irish 283

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@irish283

Hello, I had my TKR done 8/2019. I had allergy testing 14 mos.after my surgery. I had pain and swelling and severe pain that caused me to see over 9 doctors. One doctor sent me for allergy testing for metals, glues and antibiotics. This was a back patch test. I tested positive for Neomycin sulfate and methyl methylacrolate, which is a bonding agent for the cement that is used to have your prosthetic bond with you knee and make the prosthetic steady and knee strong. I had swelling pain and the band of tightness after this surgery and unfortunately still get it. I did see one final doctor at Mt. Sinai in NYC. He had me take a very specific blood test (not covered by insurance) which checked what was going on inside my body. The first allergy test only tested for topical reactions. That’s why he had me take this other blood test. It showed I didn’t have an allergy to the cement, or any metal components. But the antibiotic used during surgery was Gentamycin, which is part of the Neomycin family. You might want to speak with Dr. Darwin Chen , he was the doctor who had me take the extensive blood test. It did give me peace of mind, knowing that I wasn’t having another knee replacement done, but was upset knowing that I was still having pain . It varies from day to day the severity, tightness, etc.
Dtr. Chen did not recommend doing a revision just because of pain.
Allergy testing at least will give you information you do not have at the moment. Good luck. @irish 283

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Thanks, it all sounds so familiar, had one doctor suggest another surgery but have had two and see nothing to gain.

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@glendahofsess

1st Surgeon referred me to 2nd Surgeon as the knee implant he uses with nickel allergies is oxinium, It has traces of chromium. I am allergic to both nickel & chromium.

2nd Surgeon uses Persona titanium for nickel allergies which he says has no detectable chromium in it.

I had a titanium piece of metal taped to my arm for 7 days, I had 2 red spots when it was removed. 1 looked like the beginning of an infection.

I am very lucky to be researching this metal sensitivities before any TKR or ankle surgeries.

3rd Surgeon was for my collapsed right ankle & foot issues. all caused from my bowed right knee problems. This Doc told me I needed 2 foot surgeries to correct ankle collapse. No arthritis in foot, He did not give me specifics on metals used but said he could remove metal if allergy issues.

After all of this, I decided I do not want to rush into surgeries without further consults. Thank you to Mayo & this group.

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Hi ! I need a full knee replacement but I am allergic to Nickel. I am looking for surgeons who have the skills to place Nickel free implants like Smith and Nephew Oxinium. I see from your post that you have seen 3 different surgeons. Is there any chance you can share their names with me? That would save me a lot of time doing drastic research (if only I knew where to start). Thank you so much ! Caroline

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I used Ortiguerra at Mayo clinic Jacksonville. He gave me a ceramic knee— no nickel.

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@irish283

Hello, I had my TKR done 8/2019. I had allergy testing 14 mos.after my surgery. I had pain and swelling and severe pain that caused me to see over 9 doctors. One doctor sent me for allergy testing for metals, glues and antibiotics. This was a back patch test. I tested positive for Neomycin sulfate and methyl methylacrolate, which is a bonding agent for the cement that is used to have your prosthetic bond with you knee and make the prosthetic steady and knee strong. I had swelling pain and the band of tightness after this surgery and unfortunately still get it. I did see one final doctor at Mt. Sinai in NYC. He had me take a very specific blood test (not covered by insurance) which checked what was going on inside my body. The first allergy test only tested for topical reactions. That’s why he had me take this other blood test. It showed I didn’t have an allergy to the cement, or any metal components. But the antibiotic used during surgery was Gentamycin, which is part of the Neomycin family. You might want to speak with Dr. Darwin Chen , he was the doctor who had me take the extensive blood test. It did give me peace of mind, knowing that I wasn’t having another knee replacement done, but was upset knowing that I was still having pain . It varies from day to day the severity, tightness, etc.
Dtr. Chen did not recommend doing a revision just because of pain.
Allergy testing at least will give you information you do not have at the moment. Good luck. @irish 283

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UPDATE FROM IRISH283
Saw Doctor#10…I never intended to see any other doctor. But my P.T mentioned how this doctor had helped another of his P.T. Patients. He seems to feel that my prosthetic is too loose laterally and when walking it
“Catches”. One other doctor from Charlotte, N.C. Said the same thing.! I will be going back in 5 weeks to talk about how he would surgically proceed. He also wants me to strengthen my quads. I do know that the procedure is not a total revision. I will keep you updated! Irish283

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@irish283

UPDATE FROM IRISH283
Saw Doctor#10…I never intended to see any other doctor. But my P.T mentioned how this doctor had helped another of his P.T. Patients. He seems to feel that my prosthetic is too loose laterally and when walking it
“Catches”. One other doctor from Charlotte, N.C. Said the same thing.! I will be going back in 5 weeks to talk about how he would surgically proceed. He also wants me to strengthen my quads. I do know that the procedure is not a total revision. I will keep you updated! Irish283

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Can’t wait to read your next after visit post. I am full of metal, rods, plates, pins, stainless steel cable ties. You are awesome to share this. I have often thought my legs do not match in length after 3 femur breaks. 🙏🙏🙏💕💕💕💕

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@irish283

Hello, I had my TKR done 8/2019. I had allergy testing 14 mos.after my surgery. I had pain and swelling and severe pain that caused me to see over 9 doctors. One doctor sent me for allergy testing for metals, glues and antibiotics. This was a back patch test. I tested positive for Neomycin sulfate and methyl methylacrolate, which is a bonding agent for the cement that is used to have your prosthetic bond with you knee and make the prosthetic steady and knee strong. I had swelling pain and the band of tightness after this surgery and unfortunately still get it. I did see one final doctor at Mt. Sinai in NYC. He had me take a very specific blood test (not covered by insurance) which checked what was going on inside my body. The first allergy test only tested for topical reactions. That’s why he had me take this other blood test. It showed I didn’t have an allergy to the cement, or any metal components. But the antibiotic used during surgery was Gentamycin, which is part of the Neomycin family. You might want to speak with Dr. Darwin Chen , he was the doctor who had me take the extensive blood test. It did give me peace of mind, knowing that I wasn’t having another knee replacement done, but was upset knowing that I was still having pain . It varies from day to day the severity, tightness, etc.
Dtr. Chen did not recommend doing a revision just because of pain.
Allergy testing at least will give you information you do not have at the moment. Good luck. @irish 283

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I thank you for sharing this information about allergy testing of knee prosthetic and cement . I am worried that I might be having an allergic reaction to my implant. I wanted to ask if you could tell me the name of the specific blood test that Dr Chen ordered. Thank you

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I believe the poster was referring to the test by Orthopedic Analyses, LLC in Chicago. See https://www.orthopedicanalysis.com/order-testing-panel, specifically test #2. I have had a TKR and a Revision to the tibial component which showed no cement left on the tibial component. The doc literally lifted the prosthetic out of my leg, no chiseling. Now, 3 years later, I've got a loose prosthesis yet again. We've done blood work, a CT and I'm waiting for my Nuclear Bone Scan. If I show up with a "hot" knee again, we really have to determine why my body keeps "eating" the cement. On the revision surgery, they found a fracture in the tibial plateau on the far right side which they "built up" with cement. Now the bone and cement are gone. I have an empty spot right below the tibial plateau. This is all so scary and when I mention the concept of allergies to bone cement components or even metal parts (I know I am allergic to Nickel) I get the typical answer of "that is almost impossible or I've never heard of that being an issue". However, when I read this forum, it becomes clear to me that for some of us it is an issue. But geez, what is one suppose to do?

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