DELAYED HYPERSENSITIVITY TO METALS IN TOTAL KNEE PROSTHESIS – A REALITY TO KEEP IN MIND
Autor(a) principal: | |
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Data de Publicação: | 2015 |
Outros Autores: | , |
Tipo de documento: | Artigo |
Idioma: | por |
Título da fonte: | Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
Texto Completo: | https://doi.org/10.29021/spdv.73.2.376 |
Resumo: | Delayed-type hypersensitivity to metals in patients with orthopedic implants may cause cutaneous lesions and/or pain, effusion and functional impairment of the prosthesis. As these signs are common to periprosthetic joint infection, the differential diagnosis is difficult, but metal hypersensitivity has to be considered as a possible cause of this growing problem. Seven months after total knee arthroplasty, a female patient developed pain and functional impairment of the knee, cutaneous erythema, swelling and a nodule with serous-hematic drainage in the inferior limit of the surgical scar. Microbiologic study was repeatedly negative. Patch testing showed reactivity to chromium (potassium dichromate 0.5% pet), a constituent of the metallic prosthesis, and also to titanium oxide 0.5% pet, neomycin 20% pet and gentamicin 20% pet, which might explain the inflammatory reaction surrounding the prosthesis. Although rare, there is an association between metal hypersensitivity and implant failure. Therefore, in the presence of skin lesions around the prosthesis implantation site, metal hypersensitivity should be considered and studied. |
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DELAYED HYPERSENSITIVITY TO METALS IN TOTAL KNEE PROSTHESIS – A REALITY TO KEEP IN MINDHIPERSENSIBILIDADE RETARDADA A METAIS DE PRÓTESE TOTAL DO JOELHO – UMA REALIDADE A TER EM CONTAArthroplastyReplacementknee/adverse effectsHypersensitivitydelayedKnee prosthesisMetalsPatch testsArtroplastia do joelho/efeitos adversosHipersensibilidade retardadaMetaisPróteses do joelhoTestes epicutâneosDelayed-type hypersensitivity to metals in patients with orthopedic implants may cause cutaneous lesions and/or pain, effusion and functional impairment of the prosthesis. As these signs are common to periprosthetic joint infection, the differential diagnosis is difficult, but metal hypersensitivity has to be considered as a possible cause of this growing problem. Seven months after total knee arthroplasty, a female patient developed pain and functional impairment of the knee, cutaneous erythema, swelling and a nodule with serous-hematic drainage in the inferior limit of the surgical scar. Microbiologic study was repeatedly negative. Patch testing showed reactivity to chromium (potassium dichromate 0.5% pet), a constituent of the metallic prosthesis, and also to titanium oxide 0.5% pet, neomycin 20% pet and gentamicin 20% pet, which might explain the inflammatory reaction surrounding the prosthesis. Although rare, there is an association between metal hypersensitivity and implant failure. Therefore, in the presence of skin lesions around the prosthesis implantation site, metal hypersensitivity should be considered and studied.As reacções de hipersensibilidade retardada (HSR) a metais em doentes com próteses ortopédicas podem causar lesões cutâneas e/ou inflamação dos tecidos peri-protésicos com dor e/ou compromisso funcional da prótese. Muitos destes sinais são comuns à infecção peri-protética o que coloca importantes dificuldades no diagnóstico diferencial deste problema crescente. Uma doente do sexo feminino, 7 meses após artroplastia total do joelho (ATJ) desenvolveu dor e limitação funcional com derrame peri-articular e placa inflamatória em redor da cicatriz com nódulo que drenava material sero-sanguinolento. As culturas deste material e de líquido articular, obtido por artrocentese, foram repetidamente negativas e não se observou melhoria com múltiplos antibióticos usados de forma empírica, afastando a hipótese de infecção da prótese. Foram então realizados testes epicutâneos que revelaram reacções positivas ao dicromato de potássio 0.5% vas e óxido de titânio 0.5% pet, presentes na liga metálica da prótese, o que pode explicar a sintomatologia apresentada. Apesar de não estar estabelecida de forma definitiva a importância da relação entre a sensibilidade cutânea a metais e as reacções de hipersensibilidade peri-implante com a consequente falência de implantes protéticos, esta possibilidade deve ser evocada perante lesões cutâneas junto ao local de implantação de próteses.Sociedade Portuguesa de Dermatologia e Venereologia2015-07-01T00:00:00Zjournal articleinfo:eu-repo/semantics/articleinfo:eu-repo/semantics/publishedVersionapplication/pdfhttps://doi.org/10.29021/spdv.73.2.376oai:ojs.revista.spdv.com.pt:article/376Journal of the Portuguese Society of Dermatology and Venereology; Vol 73 No 2 (2015): Abril / Junho; 275-278Revista da Sociedade Portuguesa de Dermatologia e Venereologia; v. 73 n. 2 (2015): Abril / Junho; 275-2782182-24092182-2395reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãoinstacron:RCAAPporhttps://revista.spdv.com.pt/index.php/spdv/article/view/376https://doi.org/10.29021/spdv.73.2.376https://revista.spdv.com.pt/index.php/spdv/article/view/376/344Ramos, LeonorSimões, P.Gonçalo, M.info:eu-repo/semantics/openAccess2022-10-06T12:34:53Zoai:ojs.revista.spdv.com.pt:article/376Portal AgregadorONGhttps://www.rcaap.pt/oai/openaireopendoar:71602024-03-19T16:10:53.114328Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informaçãofalse |
dc.title.none.fl_str_mv |
DELAYED HYPERSENSITIVITY TO METALS IN TOTAL KNEE PROSTHESIS – A REALITY TO KEEP IN MIND HIPERSENSIBILIDADE RETARDADA A METAIS DE PRÓTESE TOTAL DO JOELHO – UMA REALIDADE A TER EM CONTA |
title |
DELAYED HYPERSENSITIVITY TO METALS IN TOTAL KNEE PROSTHESIS – A REALITY TO KEEP IN MIND |
spellingShingle |
DELAYED HYPERSENSITIVITY TO METALS IN TOTAL KNEE PROSTHESIS – A REALITY TO KEEP IN MIND Ramos, Leonor Arthroplasty Replacement knee/adverse effects Hypersensitivity delayed Knee prosthesis Metals Patch tests Artroplastia do joelho/efeitos adversos Hipersensibilidade retardada Metais Próteses do joelho Testes epicutâneos |
title_short |
DELAYED HYPERSENSITIVITY TO METALS IN TOTAL KNEE PROSTHESIS – A REALITY TO KEEP IN MIND |
title_full |
DELAYED HYPERSENSITIVITY TO METALS IN TOTAL KNEE PROSTHESIS – A REALITY TO KEEP IN MIND |
title_fullStr |
DELAYED HYPERSENSITIVITY TO METALS IN TOTAL KNEE PROSTHESIS – A REALITY TO KEEP IN MIND |
title_full_unstemmed |
DELAYED HYPERSENSITIVITY TO METALS IN TOTAL KNEE PROSTHESIS – A REALITY TO KEEP IN MIND |
title_sort |
DELAYED HYPERSENSITIVITY TO METALS IN TOTAL KNEE PROSTHESIS – A REALITY TO KEEP IN MIND |
author |
Ramos, Leonor |
author_facet |
Ramos, Leonor Simões, P. Gonçalo, M. |
author_role |
author |
author2 |
Simões, P. Gonçalo, M. |
author2_role |
author author |
dc.contributor.author.fl_str_mv |
Ramos, Leonor Simões, P. Gonçalo, M. |
dc.subject.por.fl_str_mv |
Arthroplasty Replacement knee/adverse effects Hypersensitivity delayed Knee prosthesis Metals Patch tests Artroplastia do joelho/efeitos adversos Hipersensibilidade retardada Metais Próteses do joelho Testes epicutâneos |
topic |
Arthroplasty Replacement knee/adverse effects Hypersensitivity delayed Knee prosthesis Metals Patch tests Artroplastia do joelho/efeitos adversos Hipersensibilidade retardada Metais Próteses do joelho Testes epicutâneos |
description |
Delayed-type hypersensitivity to metals in patients with orthopedic implants may cause cutaneous lesions and/or pain, effusion and functional impairment of the prosthesis. As these signs are common to periprosthetic joint infection, the differential diagnosis is difficult, but metal hypersensitivity has to be considered as a possible cause of this growing problem. Seven months after total knee arthroplasty, a female patient developed pain and functional impairment of the knee, cutaneous erythema, swelling and a nodule with serous-hematic drainage in the inferior limit of the surgical scar. Microbiologic study was repeatedly negative. Patch testing showed reactivity to chromium (potassium dichromate 0.5% pet), a constituent of the metallic prosthesis, and also to titanium oxide 0.5% pet, neomycin 20% pet and gentamicin 20% pet, which might explain the inflammatory reaction surrounding the prosthesis. Although rare, there is an association between metal hypersensitivity and implant failure. Therefore, in the presence of skin lesions around the prosthesis implantation site, metal hypersensitivity should be considered and studied. |
publishDate |
2015 |
dc.date.none.fl_str_mv |
2015-07-01T00:00:00Z |
dc.type.driver.fl_str_mv |
journal article info:eu-repo/semantics/article |
dc.type.status.fl_str_mv |
info:eu-repo/semantics/publishedVersion |
format |
article |
status_str |
publishedVersion |
dc.identifier.uri.fl_str_mv |
https://doi.org/10.29021/spdv.73.2.376 oai:ojs.revista.spdv.com.pt:article/376 |
url |
https://doi.org/10.29021/spdv.73.2.376 |
identifier_str_mv |
oai:ojs.revista.spdv.com.pt:article/376 |
dc.language.iso.fl_str_mv |
por |
language |
por |
dc.relation.none.fl_str_mv |
https://revista.spdv.com.pt/index.php/spdv/article/view/376 https://doi.org/10.29021/spdv.73.2.376 https://revista.spdv.com.pt/index.php/spdv/article/view/376/344 |
dc.rights.driver.fl_str_mv |
info:eu-repo/semantics/openAccess |
eu_rights_str_mv |
openAccess |
dc.format.none.fl_str_mv |
application/pdf |
dc.publisher.none.fl_str_mv |
Sociedade Portuguesa de Dermatologia e Venereologia |
publisher.none.fl_str_mv |
Sociedade Portuguesa de Dermatologia e Venereologia |
dc.source.none.fl_str_mv |
Journal of the Portuguese Society of Dermatology and Venereology; Vol 73 No 2 (2015): Abril / Junho; 275-278 Revista da Sociedade Portuguesa de Dermatologia e Venereologia; v. 73 n. 2 (2015): Abril / Junho; 275-278 2182-2409 2182-2395 reponame:Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) instname:Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação instacron:RCAAP |
instname_str |
Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
instacron_str |
RCAAP |
institution |
RCAAP |
reponame_str |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
collection |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) |
repository.name.fl_str_mv |
Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos) - Agência para a Sociedade do Conhecimento (UMIC) - FCT - Sociedade da Informação |
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