William M. Mihalko, MD; Stuart B. Goodman, MD; Nadim J. Hallab, PhD; and Joshua J. Jacobs, MD
Cutaneous reactions to metals used in orthopaedic implants have been well documented since the 1970s. Recently, a rise in the incidence of cutaneous reactions has been ascribed to certain metals and types of implants. Whether cutaneous reactions are the dominant symptom associated with hypersensitivity responses to implanted orthopaedic devices is controversial.
Some reports have shown a poor correlation between skin testing and implanted materials. A recent study in the Archives of Dermatology, however, reported a correlation between patients who had a poor outcome after total knee arthroplasty (TKA) and positive skin patch testing that indicated metal sensitivity. Although this study may have implications for future screening of patients before scheduling elective surgery that involves an implanted metallic medical device, based on the totality of the available evidence, we, the authors, believe that it is not prudent to recommend routine screening for metal hypersensitivity prior to TKA using either patch or in vitro testing modalities.