| Abstract [eng] |
Aim: The aim of this study was to review the literature, analyse, and understand the mechanism and clinical features of metal hypersensitivity, discuss the main diagnostic methods and treatment options for metal allergy, and describe a relevant clinical case. Methods: The literature search was performed in the PubMed database. The selection criteria were: English language and publications between the years 2000 and 2022. According to the selection criteria and the relevant keywords, 95 scientific publications were identified in the PubMed database, of which 41 were selected for the final literature review. Data storage was performed with Zotero reference management software. Case report: A 53-year-old male patient presented to the Vilnius University Hospital Santaros Clinics in 2020 with right knee joint swelling and pain, and an inability to move the right leg, with a history of right knee arthroplasty due to gonarthrosis performed in 2019. Due to persisting swelling, a puncture of the right knee joint was performed and 100 ml of serohemorrhagic synovial fluid was obtained. The synovial fluid analysis showed an elevated leukocyte count (6,9*10 9/l). A radiograph of the right knee joint showed osteolysis around the tibial component, therefore, revision surgery was performed, during which microbiological cultures were taken and a positive Synovasure Alpha Defensin test was obtained. Due to a suspected infectious inflammation, cemented inserts were implanted. Histological examination of the joint capsule showed an increased CD4+/CD8+ T-lymphocyte ratio. The patient was also consulted by an allergologist, who performed a skin patch test and diagnosed an allergy to nickel, cobalt, titanium, manganese, palladium, beryllium, and silver. The second stage of the revision surgery was performed in 2021 and a zirconium-coated prosthesis was implanted. A year after surgery, the patient has no complaints. Conclusions: Metal allergy is classified as type IV delayed hypersensitivity reaction. Clinically, the reactions manifest with joint pain and swelling, reduced range of motion, and prosthesis dislocation. The diagnosis of metal hypersensitivity should be based on a combination of several tests. The most popular tests are skin patch and lymphocyte transformation tests. A histologically confirmed increase in the ratio of synovial CD4+ to CD8+ cells indicates metal hypersensitivity. In patients for whom the choice of prosthetic alloys is not possible due to metal sensitivity, surgery with a zirconium-coated prosthesis is recommended. |
