I have a metal allergy, can I have a hip resurfacing?

"Allergy after artificial joints is an interesting issue. One must keep in mind that the co-cr-mo alloy has been in clinical use for 45 yrs and is present in 99% of all hip and knee replacement surgery. Even if a component is titanium the articulating part would be always co-cr-mo. Therefore metal sensitivity is not exclusive to metal on metal joints. It is a factor in every joint replacement surgery and therefore has been used in millions of patients. Skin allergy is quite different from deep tissue allergy which is mediated by different mechanisms of immune response by the body. Thus skin testing is of no value when trying to gauge deep tissue hypersensitivity. There have been reports of hundreds of patients who had skin sensitivity but went on to have very successful resurfacing. Only one thing can be said about deep tissue sensitivity at this point in time --- it is very very rare.

with best regards

vijay bose chennai
 

Dr. De Smet writes that although very rare, a reaction can occur after a BHR hip replacement. The following is a story about a problem that Dr. De Smet thinks is associated with a metal sensitivity in a BHR.

Sent: Thursday, November 08, 2007
Subject: [surfacehippy] Re: Metal allergy - an OS writes


While metal allergies are indeed rare, they can be (or have the effect of being) all too real.....

My wife is 31 yrs old and had her right hip resurfaced 2 years ago by Dr. De Smet (she originally broke her hip around 10 years, developed AVN, had an osteotomy 7 years ago, developed arthritis, which ultimately led us to Ghent - can't say enough about the experience there).

Around a month ago she started experiencing terrible hip pain. X-rays (and a CT Scan) show that the bone just below the bottom end of the femoral cap is essentially dissolving (osteolysis).

Blood tests were performed and, while it is not an exact science, there does appear to be sensitivity to both chromium and nickel - chromium being one of the main by-products of the resurfacing components.

While there certainly could be other factors at play (e.g. improper load bearing due to prior surgeries/injuries or decay of the cement used in the femoral cap [which, according to one prominent surgeon I spoke to, can happen, particularly in cases where the femoral head has already been significantly damaged]), I don't believe it. Both of those factors can, I believe, be worked through with exceptional surgical technique - and I have the utmost confidence in De Smet.

According to De Smet, around 1 out of every 500 patients has this type of reaction to the metal. To quote De Smet, "That indeed is a possibility. Metal sensitivity is a risk of 1/500 in my series. A lot of people do not believe it and say it is non existing or very rare. If [metal] is the problem......she has really bad luck".
We are now looking at a THR (which will most likely happen in the next week or so) and, while there is no way to know for certain whether a "metal allergy" is causing the problem, at this point, we certainly can't risk having a MoM THR - ceramic is the only option.
Joel Feldman (Meg: De Smet - Sept 05)

 

"Allergy" in some ways seems almost the new "designer disease" of
the First world. We are told that there are allergies to everything
from bee stings, pollen, cosmetics, a myriad of drugs, down to foods
such as gluten etc. In some ways it seems a miracle some of us
survive life without allergies!

There is NO DOUBT some of these allergies are genuine, a terrible
daily problem and even life threatening. But a lot is also hysteria.
Or attention seeking. And there are plenty of quacktitioners out
there making a good living from the hysteria. So the illusion that
most allergies are genuine is perpetuated. Truth is it is a
nightmarishly complicated mixture.

As a medical practitioner please just take it from me and do not
condemn me when I tell you that it is almost always the nervous and
introspective patients who have a long list of 'allergies'. Not
always, but often enough to make the generalisation. It is the ideal
self-diagnosis "Oh, I can't have that, I am allergic". End of
discussion.It would be a harmless distraction, but it limits the drugs or
treatments such persons can have, as no-one wants to take the risk
of going against the reported 'allergy'. This may have serious
consequences as the treating practitioner may use a less than ideal
treatment or drug for fear of provoking a reaction and then being
held liable. "I told you so Dr."

So it comes down to a question of just how reliable are the tests
for metal allergy? The whole problem is that the tests are NOT
reliable for IMPLANTED metal. Skin tests for metal allergy, test
only that - not what will happen if the metal is implanted. You can
be skin sensitive to a metal, yet have something implanted of the
same metal, but live quite happily with the same. We know this
because the reported rate of surface metal 'allergy' [for instance
to jewellery] is much higher than the rate of reaction to implanted
metals of all types - plates, screws, nails, joint prostheses etc.

I have implanted >750 Smith & Nephew hip resurfacings and work in an
area where many more are put in by colleagues. I also speak to
colleagues at meetings, and there may be a very, very
rare 'allergic' reaction called ALVAL [can't rememeber what that
stands for] but you cannot predict it's development from skin
testing, or [as far as I am aware] from blood testing.

So to those of you worried about this subject: yes, you may turn out
to be allergic or react to a resurfacing. But the chances are so
infinitesimally small it is not worth the effort worrying about it.
And no, I personally do not believe the tests are reliable. I could
be wrong as tests change or advance as technology does. But I am not
aware of a recent advances that would change the above.