Shoulder
The effect of patient-reported metal allergies on the outcomes of shoulder arthroplasty

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Background

Although literature exists regarding hip and knee arthroplasty outcomes in patients with skin allergy to metals, there is minimal information about skin allergy implications on shoulder arthroplasty outcomes. The purpose of this study was to determine the results, complications, and failure rate among patients with a self-reported metal allergy undergoing shoulder arthroplasty.

Methods

Fifty-two shoulder arthroplasties were performed at our Institution in 43 patients with self-reported metal allergies. Forty primary and 12 revision shoulder arthroplasties were performed using anatomic (30) and reverse (22) components. Retrospective chart review was performed to determine metal allergy history, implant composition, pain, motion, and complications. Radiographs were reviewed to determine mechanical failure rates. Average follow-up time was 65 months.

Results

Allergies reported included nickel (37), cobalt chrome (4), copper (2), zinc (1), titanium (1), gold (1), and nonspecific metal allergy (8); 8 patients reported multiple metal allergies. All components implanted in patients with nickel allergies contained nickel. At most recent follow-up, pain was rated as none or mild in 88% of shoulders. Active elevation improved from 80° to 141° and external rotation from 24° to 52°. Two revisions were performed for glenoid loosening (3.8%); both were revision cases with substantial glenoid bone loss. One patient with mild pain had a radiographically loose glenoid component 12 years after anatomic shoulder arthroplasty.

Conclusion

Results from this study suggest that shoulder arthroplasty in patients with self-reported metal allergy provides satisfactory pain relief and improved range of motion with low revision rates.

Section snippets

Materials and methods

Following Institutional Review Board approval, a retrospective review was conducted of patients undergoing 3252 shoulder arthroplasties between January 2006 and April 2015 performed at a single institution. Patients aged >18 years undergoing shoulder arthroplasty with at least 1 self-reported metal allergy and a minimum 2-year follow-up (mean 5.4 years, range 2-15.2 years) were included in the study. All surgeries were performed by 6 reconstructive shoulder surgeons.

There were 43 patients with

Results

The incidence of self-reported metal allergy was 1.6% in this shoulder arthroplasty–specific population.

Discussion

This study reports on the outcomes of 52 shoulder arthroplasty patients with self-reported and/or patch-test confirmed metal allergies. Clinical outcomes and reoperation rates at a single institution suggest that shoulder arthroplasty implants can be safely placed in patients with self-reported metal allergies. Moreover, this investigation shows significant and reliable improvements in range of motion and pain relief without significant radiographic evidence of loosening. This experience

Conclusion

Results from this study suggest that shoulder arthroplasty in the setting of self-reported metal allergy offers satisfactory pain relief and improved range of motion with a low revision rate. Optimized diagnostic techniques are needed to better diagnose and understand the implications of metal allergy in the setting of shoulder arthroplasty.

Disclaimer

The authors, their immediate families, and any research foundations with which they are affiliated have not received any financial payments or other benefits from any commercial entity related to the subject of this article.

References (25)

  • A. Carlsson et al.

    Implantation of orthopaedic devices in patients with metal allergy

    Acta Derm Venereol

    (1989)
  • M. Faschingbauer et al.

    Allergy in total knee replacement. Does it exist? Review article

    HSS J

    (2017)

    • Cited by (0)

    Approval for this study was received from the Mayo Clinic Institutional Review Board (no. 16-006966).

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    © 2019 Published by Elsevier Inc. on behalf of Journal of Shoulder and Elbow Surgery Board of Trustees.