Background

Metal allergy may be an uncommon cause of prosthetic joint failure. There exist little data on patch testing to metals in this context and its impact on outcomes of joint revision in these patients.

Objective

To explore the use and indications for metal patch testing in the evaluation of patients suspected of having metal allergy as a cause of failed joint replacements and to clarify the outcomes of patients revised with alternative metallic joints because of positive patch testing result.

Methods

A retrospective analysis from January 2016 to April 2020 was completed on a patient cohort referred for evaluation of metal hypersensitivity. Charts were reviewed for age, biological sex, referring specialty, patch testing results, joint, revision status, and outcome measures. Biostatistical analysis and descriptive statistics were performed to determine patch testing performance and functional outcome trends among this patient cohort.

Results

The sensitivity and specificity of patch testing, in general, are limited when evaluating patients with metallic joint replacements. However, the predictive value of testing seemed to improve with strongly positive patch testing results. Functional outcomes in patients when positive results were used to guide revision prosthesis revealed clinical improvement.

Conclusion

The attribution of metal allergy or hypersensitivity as a cause of failure in metal prosthetic joint replacement remains unproven. Some patients with positive histories and patch testing results that were used to modify the implanted prosthesis had improved functional outcomes. These results suggest that patch testing may be useful in patients with history of metal sensitivity and prosthetic failure.

中文翻译：

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金属斑贴测试在评估患者金属假体关节衰竭中的作用

背景

金属过敏可能是假体关节衰竭的常见原因。在这种情况下，关于金属的斑贴测试及其对这些患者的关节翻修结果的影响的数据很少。

客观的

探索金属贴剂测试在评估怀疑是金属过敏导致关节置换失败的原因的患者中的用途和适应症，并阐明由于贴剂测试结果阳性而使用其他金属关节翻修的患者的结局。

方法

从2016年1月至2020年4月，对用于评估金属超敏性的患者队列进行了回顾性分析。对图表进行了年龄，生物学性别，参考专业，斑贴测试结果，关节，修订状态和结果测量的审查。进行了生物统计学分析和描述性统计，以确定该患者队列中的斑贴测试性能和功能结局趋势。

结果

通常，在评估使用金属关节置换术的患者时，斑贴试验的敏感性和特异性有限。但是，强阳性斑贴测试结果似乎可以提高测试的预测价值。当使用阳性结果指导翻修假体时，患者的功能预后显示出临床改善。

结论

金属过敏或超敏反应是造成金属假关节置换失败的原因，目前尚无定论。具有改良的假体历史和修补测试结果的一些患者的功能预后得到了改善。这些结果表明，斑贴测试可能对具有金属敏感性和假体衰竭病史的患者有用。