Metal Allergy Testing

[nwugrad]

I met a woman in November who was a professional dancer at the Hospital of Special Surgery Pre Hip Surgery Orientation.  She was scheduled for a resurfacing but apparently, after her pre operation testing was contacted by Dr. Su's office and told that she had Metal Allergies which would prevent her from getting a resurfacing. 

Is metal allergy testing a standard test done via blood test as part of pre op testing?  Otherwise, how and when is testing done for metal allergies?

[stevel]

Mike,

A blood test procedure is outlined in "In-vitro metal hypersensitivity testing - assay methodology" by Rush University.

[karenj_m]

Nwugrad:
I have (skin) allergy to metal or junk cosmetic jewerly = even silver jewerly.

I had 4 pins put in my hip at age 14 1/2 = no reaction
I had a osteotomy and a shim put in at age 16 (some kind of tin material per my surgeon) = I got 2 different "staff" infections (not allergies)

Dr. Gross and Lee Webb, have told "me" that skin allergy to metal is NOT the same as deep tissue metal allergy. He also said that many university types of places are trying to come out with a good metal allergy testing program, because the ones out there (right now) are not conclusive.

I have a resurfacing...and am doing well - no problems.

Below is Dr. Bose (India) response on the whole matter (from Pat's website)"


"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   

[Bionic]

Dr. Gross told me that the only good test for metal sensitivity is a pathology test, i.e., one performed AFTER the patient has already received the implants.  There is no good test for predicting whether any given person who has never received implants will have an adverse reaction to them.

On the other hand, if a person has already had an adverse reaction to an implant, say, in a hip or a knee, it is probably a good bet that same person will also have an adverse reaction to a new implant installed elsewhere in the body.

I think the dancer should seek a second opinion.

[nwugrad]

I guess my question is how did they discover just a few days in advance of her surgery that she had a metal allergy?  Is testing for metal allergies a part of the standard pre op testing?

Additionally, she was at the pre hip surgery orientation because now instead of having a resurfacing she was going to get a replacement.  Would the replacement devices be less likely to cause metal allergies?

[stevel]

I didn't have any pre-op testing for metal allergies for my surgery last September by Dr. Su.

The woman could be receiving a Ceramic THR.  I bumped into a woman at HSS who received a ceramic THR by Dr. Su because her hip resurfacing socket had been placed at too steep an angle (by a different doctor at another facility) and her soft tissues exhibited metal debris from excessive wear.

[lindalynn]

I have made a new posting for metal allergies.  anyone checking this site... I am interested in discussion.

[littleb]

Can we get back to this issue. I just saw Dr. Su today for the first time do discuss replacement vs resurfacing and as soon as I said cheap jewelry turned my finger green he said no to resurfacing. I'm really bummed out by this and wonder if this is standard HSS protocol now of just him. Should I get another opinion?

[lindalynn]

I didn't know that turning your finger green meant allergy?  All I can say is I have a resurfacing that is not doing well and that my finger also turned green with cheap jewelry.  I thought this happen to everyone with cheap jewelry.  Anyway I later skin tested positive to nickel and chromium but unfortunately I already have the hip and as I said it is not doing well.

Forget the second opinion and start planning traditional hip.  That is my advise.

Lynn

[Dayton96]

I'm a little confused by this issue of metal allergy testing.  I was told by Dr. Gross' office, when I asked about the possibility of metal allergy testing prior to surgery, that the "implants are made of chromium, a mineral in your body, there are no allergies to the metal."

[littleb]

I spoke to my boyfriend, the scientist, about it and he said Cobalt is near nickel on the periodic table so I guess that means similarities of some sort but chromium was not near it and should not be the problem. I always thought brass was the problem with cheap jewelry but forget what brass is made from. I'll have to ask boyfriend.
Where did you get the allergy testing? Traditional scares me more than resurfacing. Here I was worried about bone density and it's cheap jewelry that's going to shoot me down. Isn't traditional made of the same stuff? How is that better? I admit I am afraid. I'm only going to be 54 in July. I was sitting in the waiting room with a lady of 86 who is having THR, If I live as long as her I'll need a revision.

[Lopsided]

...as soon as I said cheap jewelry turned my finger green he said no to resurfacing...

I am not sure I would put up with that. Cheap Jewelery is a long way from hi tech medical implants. Dr. Su seems to be one of the better surgeons recommended on this site, so I think you should ask him to qualify that.

[lindalynn]

I agree.  Dr. Su seems to be one of the most respected surgeon doing hip resurfacing.  I would lean towards listening to his advise. There is nothing worse than going through surgery and not getting the results you wanted and perhaps being worse off.

[stevel]

Interesting subject.  I looked up why a finger turns green due to cheap jewelry and an explanation is that the jewelry contains copper which reacts with the salts on your skin and leaves a green residue (copper sulfate).
This is a lot different that an allergy.  This is also a lot different than a reaction to a embedded chromium, cobalt, molybdenum alloy hip implant that is exposed to internal fluids such as blood and synovial fluid.
I wear 14 karat gold jewelry and I have never had any skin reaction to the jewelry.  14 karat gold jewelry is an alloy consisting of 14 karats of gold where pure gold is 24 karats.
A jeweler advised that the alloy improves wearability compared to pure gold.  14 karat gold jewelry is still expensive.
Be interested to hear what Dr. Su has to say.

[dimples]

Hi,
I knew I had a nickel allergy before my resurfacing.  When I told my Dr., his first reaction was to tell me that we would have to do a total hip replacement.  I refused the THR and asked him if he would do the resurfacing if I signed a release form acknowledging that I knew I had a nickel allergy, knew I might have an allergic reaction to it, and would not hold him responsible.  He agreed.  That was 2 years ago and I have not had any complications so far with my new hip!
Please do more research.  Having a nickel allergy does not always mean that you can't get resurfacing!
Delynn
LBHR 4/30/08

[sarahb]

Interesting .... I definately have an allergy to the metal implant    I have never really had any allergies before all this, cheap jewellery included, but 7 months post op, I am now down to have ceramic thr on the 25.8.10.  

Still, on the positive side, if I hadn't have tried the resurface I would never had known and whether it would have worked !!

Also interestingly, I am the only patient my surgeon has ever had with this so soon after surgery .. just how unlucky is that ?  No wonder I haven't won the lottery ! lol 

Anyway, Roll on August to get it over and done with .... xx

[littleb]

I contacted Dr. DeSmet and then went back to further discussion with Dr. Su.  There is an expensive test but still not absolute. I was willing to take the 1% chance that my finger turning green meant anything in predicting internal metal allergy. We agreed he would do the resurfacing unless he saw bone problems in which case he would do the THR. In the end I had the resurfacing one week ago today. Dr. Su was very happy with my bone condition. Post-op, so far so good though today was more painful again. I probably did too much yesterday. From what I am reading here, I'm pretty normal so far with swelling and the feeling that the operated side feel longer. My fingers remain crossed.

There is a hesitancy to doing women over 50 I have learned so the "green finger" thing may have been seen as in addition to rather than a stand alone issue.

[Spanielsal]

Hi guys, my HR is 9yrs old tomorrow, it has been great for most of that time, i certainly would never regret having it, whatever happens now as those years have been a gift.  However, i've had pain in it over the past two years, on and off to start with and constantly now.  it is concentrated in the upper hip, both at the front and through the back of my scar and on my hip bone particularly when sitting at 90 degrees or less. this pain is non responsive to painkillers, it is not agony it is a 3-7 on a 1-10 scale but it is a gnawing pain and is always there.  it has also started to clunk - the clunks are not more painful just odd.

I have problems in the other hip, prominent cysts, jointspace narrowing and flattening of the femoral head together with the dysplasia.  there is a lot of pain in the right hip but bizarrely i also have some good days when it doesn't hurt at all.  I can only sleep with sleeping pills on top of paracetamol, ibroprufen and reasonable amounts of codeine, due to both hips but levels of pills taken depend on the kind of pain i'm in at bedtime!  I've been to see someone, not yet my original surgeon due to distance but waiting for an appointment. I've had my metal ions checked twice - all fine.  I've had an MRI, no pseudotumours or fluid collection.  so why the pain?  I have always been allergic to cheap earrings and have now developed allergies to more metal such as nickel belt buckles.  Is this metal allergy to the acetabular cup or is there any other explanation for this gnawing, chewy deep bone pain?

i asked the radiologist if there might be some other explanation for the pain but the MRI cannot tell due to it being a metal prosthesis whether or not it is loosening as the scans (even with MARS) are affected by the joint.  I guess i shall have to wait to know for sure until i have another xray.  Meanwhile i'm doing as much as I can to reduce my weight (6kg so far) and have started swimming to strengthen the muscles now that i know there is no poisonous fluid in there.  Maybe it will get better if / when i get my right done but weirdly it hurts when the right is having a good day so cannot always think that it is referred pain, i hope it is though, also pain normally travels downwards.  I read above that there isn't a good test for allergy but any suggestions will be welcomed!  Sal