Patient-Reported Metal Allergy: A Risk Factor for Poor Outcomes After Total Joint Arthroplasty?

详细信息    查看全文

• 作者：Denis Nam ; MD ; MSc ; Kevin Li ; BS ; Venessa Riegler ; BA ; Robert L. Barrack ; MD
• 关键词：metal allergy ; total knee arthroplasty ; total hip arthroplasty ; clinical outcomes ; patient satisfaction
• 刊名：The Journal of Arthroplasty
• 出版年：2016
• 出版时间：September 2016
• 年：2016
• 卷：31
• 期：9
• 页码：1910-1915
• 全文大小：212 K

文摘

Metal sensitivity after total joint arthroplasty has been of increased concern, but the impact of a patient-reported metal allergy on clinical outcomes has not been investigated. The purpose of this study was to report the incidence and impact of patient-reported metal allergy after total knee arthroplasty (TKA) and total hip arthroplasty (THA).

Methods

This was a retrospective, institutional review board–approved investigation of patients undergoing a primary, elective total joint arthroplasty between 2009 and 2011. All patients completed a preoperative questionnaire asking about drug and environmental allergies. In January 2010, a specific question was added regarding the presence of a metal allergy. University of California at Los Angeles Activity, Short Form 12 (SF-12), Modified Harris Hip, and Knee Society scores were collected preoperatively and at most recent follow-up. Overall cohorts of metal allergy and nonmetal allergy patients were compared, and a 1:2 matching analysis was also performed.

Results

Nine hundred six primary THAs and 589 primary TKAs were included. The incidence of patient-reported metal allergy was 1.7% before January 2010 and 4.0% after (overall 2.3% of THAs and 4.1% of TKAs); 97.8% of metal allergy patients were female. After TKA, postoperative Knee Society Function, Symptoms, Satisfaction, and Expectation scores were all decreased in the metal allergy cohort (P < .001-.002). After THA, metal allergy patients had a decreased postoperative SF-12 Mental Component Score and less incremental improvement in their SF-12 Mental Component Score vs the nonmetal allergy cohort (P < .0001 and P = .001, respectively).

Conclusion

Patient-reported metal allergy is associated with decreased functional outcomes after TKA and decreased mental health scores after THA.