Implantable pulse generators, important in cardiac pacemakers, gastric stimulators, and neurostimulators, may include components made of stainless steel, titanium alloy, platinum and iridium, epoxy resins, poly methyl methacrylates, and isocyanates, all of which are immunogenic in some patients. CT scan was promptly ordered to rule out the severe complication of toxic megacolon as a result of C. difficile infection. A pigtail catheter is a universal drain used to remove fluids or abscesses from organs, ducts, or body cavities. document.getElementById( "ak_js_2" ).setAttribute( "value", ( new Date() ).getTime() ); We care about your privacy. Conclusions: The signs and symptoms of a late infection present a challenge in the setting of a bioabsorbable interference screw. This rapid expansion of titanium-containing products has increased percutaneous and permucosal exposure of titanium to the population. Careers. But opting out of some of these cookies may affect your browsing experience. Chronic eczema beginning weeks or months after the implant, 2. This website also contains material copyrighted by 3rd parties. Results may vary from person to person. FOIA J. S. Gammie, M. C. Banks, C. R. Fuhrman et al., The pigtail catheter for pleural drainage: a less invasive alternative to tube thoracostomy, JSLS., vol. Nickel is one of the most common allergens, and can cause local contact dermatitis characterized by itching and skin reddening. A case by Little et al. In some severe cases, allergies can trigger a life-threatening reaction known as anaphylaxis. After removal of dental implants, the eczema disappeared completely. The surgical pathology report for the removed catheter specified foreign body consisting of synthetic stent measuring 10.0cm in length and 0.3cm in diameter (Figure 4). Lachiewicz PF, Watters TS, Jacobs JJ. Plastic used if the patient is allergic to metals found in other medical staples. Contact Dermatitis. Allergy to a metal screw is very rare, so consider other issues first. Thanks so much Craig, that is good to hear! The patient has been recommended to do a close follow-up for a few months to monitor her progress. V. A. Zejnullahu, B. X. Bicaj, V. A. Zejnullahu, and A. R. Hamza, Retained surgical foreign bodies after surgery, Open Access Maced J Med Sci., vol. These assessments do not indicate that Dr. Sinicropi has performed these specific surgeries. A decision was made to remove all the metal surgical clips laparoscopically via fluoroscopic guidance (Figure 1). Cara Beth Lee, MD, is a board-certified orthopedic surgeon and Assistant Medical Director at Comagine Health in Washington. To comment please, Comments on Medscape are moderated and should be professional in tone and on topic. One-Piece Zirconia Oral Implants for Single Tooth Replacement: Five-Year Results from a Prospective Cohort Study. It also sheds light on retained foreign bodies as a possible cause of abdominal pain in patients who have gone through various surgical procedures in the past. The patient also started having low-grade fever, nausea, vomiting, joint pain, diffuse rash, and fatigue. However, the skin-patch test is still not the best diagnostic modality due to failure in positive reaction to most titanium allergy cases [3]. 1. Multiple cardiac and neurostimulatory devices are constructed of metals and adhesives that can be sensitizing in some individuals. Copyright 2016 The Authors. The delayed hypersensitivity occurs due to the natural corrosion of metals over time. Titanium is used not only for medical applications such as plastic surgery and/or dental implants, but also for paints, white pigments, photocatalysts, and various types of everyday goods. doi:10.1016/j.jaip.2020.12.068, Wang Y, Dai S. Structural basis of metal hypersensitivity. Implant-related Allergic Contact Dermatitis, Cobalt-chromiummolybdenum steel (ASTM F75), 1. Metal screws and plates are often used in surgery to fix fractures, fuse joints, or stabilize bones that have been cut (osteotomies) in the foot and ankle. Staples are used to hold skin together in order to clsoe a surgical incision or wound that is too big or complex to close with traditional sutures or stitches. It helps to understand what happens when your body comes in contact with a metal to which you're allergic. Stainless Steel material that is typically used in skin stapling and surgical clips. Accessibility Allergic reactions to staples, clips, and other metallic implants may be rare, but it can have adverse health effects on a patient. The patient did not report any screening for immunodeficiency in the past. Some people are prone to developing a response to various metals, such as skin sensitivity to jewelry or watches. On the other hand, another rare case of a female patient was also the topic of one case report. Some of the reported complications of pigtail catheter insertion include lung penetration during pleural effusion removal and entrapment of the catheter in the tricuspid valve leaflet during heart catheterization [8, 14, 15]. Bookshelf Federal government websites often end in .gov or .mil. Proper history taking, appropriate physical exams, and specific diagnostic modalities can identify rare causes of chronic abdominal pain. World J Orthop. 2022 Oct 24;14(10):e30625. G. Tawil, P. Tawil, and C. Irani, Zirconium implant as an alternative to titanium implant in a case of type IV titanium allergy: case report, The International Journal of Oral & Maxillofacial Implants, vol. However, other metal ions as well as bone cement components can cause such hypersensitivity reactions. I, too, had an allergic reaction to the two stainless steel screws used to fixate my right foot 1st MTP fusion two years ago (It is all written in posts on this board!). Symptoms can arise as acute inflammatory response, infection, abscess, or aseptic inflammation and exudative without infection in the body cavities [13]. P. H. Wu, J. H. Chen, and K. E. Chu, Successful endoscopic management of double iatrogenic perforations induced by endoscopic retrograde cholangiopancreatography and computed tomography-guided colon drainage, Case Reports in Gastroenterology, vol. Federal government websites often end in .gov or .mil. Most skin reactions are eczematous and allergic in nature, although urticarial, bullous, and vasculitic eruptions may occur. We present a case of a 28-year-old female with a chronic history of intermittent abdominal pain aggravated due to titanium allergy and retained foreign surgical body. 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. Cobalt and chromium may be found not only in the appliance but also in bone cements used to set the prosthetic. Front Immunol. In fact, they are the subjects of recently filed complaints in the surgical stapler lawsuit. 2023 Dr. Stefano Sinicropi The information contained on this site is intended to provide only general education about spine surgery and conditions. Metal Allergy to Surgical Plates, Screws, and Implants, Hip Replacement Loosening Symptoms and Causes, Problems With Metal-on-Metal Hip Replacements, What Causes Metal Implants to Break Inside the Body, Trapeziectomy: Everything You Need to Know, What to Expect When Getting Your Ears Pierced, Allergic Reactions and Sensitivities Caused by Synthroid, Causes and Risk Factors of Contact Dermatitis, Metal hypersensitivity and total knee arthroplasty. This resulted in approximately 75lbs. Medical ID Cards to Identify Metal Implants for the TSA, Trapeziectomy: Everything You Need to Know, Removing Pins and Other Surgical Implants, Problems With Metal-on-Metal Hip Replacements, Causes and Risk Factors of Contact Dermatitis, Why the Material Used for Hip Replacement Implants Matters, Allergy in total knee arthroplasty: a review of the facts, Metal hypersensitivity reactions to orthopedic implants, Biological responses to metal implants: 2019. Department of Medicine, Section of Dermatology, The University of Chicago, Chicago, IL; the National Allergy Research Centre, Department of Dermato-Allergology, Gentofte Hospital, University of Copenhagen, Denmark; and the Department of Dermatology, Massachusetts General Hospital, Harvard Medical School, Boston, MA. Jonathan Cluett, MD, is board-certified in orthopedic surgery. The pain was sharp and stabbing in nature and radiated from the umbilicus, and the patient rated the pain 10/10 on a scale, causing her significant discomfort. Cite this: Cutaneous and Systemic Hypersensitivity Reactions to Metallic Implants-Medscape-Apr01,2011. 4143, 2011. Pigtail plastic stents are used to remove the intra-abdominal drainage during procedures such as endoscopic retrograde cholangiopancreatography (ERCP) [8]. Discussion You've successfully added to your alerts. Metals and their alloys could lead to immediate or delayed hypersensitivity reactions. In fact, there is also a reported case of a patient who suffered from adverse reactions following a cholecsytectomy which made use of titanium surgical staples. 2016 Sep;31(9):1910-5. Some orthopedic implants contain small amounts of nickel, and there's been a concern that this may be an issue for nickel-sensitive people. Spinal hardware (screws, plates, rods, etc.) The patient contacted our department the next morning, and the case and CT findings were reviewed. 1 Patients with MHS reactions to implants typically have prolonged eczematous dermatitis.8 Although the majority of MHS reactions are localized, more widespread inflammation has been reported. We also use third-party cookies that help us analyze and understand how you use this website. Clipboard, Search History, and several other advanced features are temporarily unavailable. Patient-ReportedMetalAllergy: A Risk Factor for Poor Outcomes After Total JointArthroplasty? Around 15%of the general population is known to have nickel sensitivity, while 2% or more have reactions to cobalt or chromium. When determining if the patient is having an allergic reaction to their hardware, the first step is to investigate the materials that make up the hardware in question. Some implants are made of non-metal materials, such as ceramics, but there's limited data about their effectiveness and longevity. Moreover, all her aforementioned symptoms were alleviated once the metal surgical clips were removed surgically. Many people have known skin sensitivities to various metals. Individuals should always consult a licensed and qualified health care provider for evaluation, diagnosis and treatment recommendations regarding their specific spine or other medical problems. MeSH When they do occur, however, the associated pain, swelling, inflammation, and decreased range of motion can significantly impair the implant function. [6] This review aims to update the reader on the general aspects of this complex topic and to briefly discuss future challenges. An official website of the United States government. 2023 Dotdash Media, Inc. All rights reserved, Verywell Health uses only high-quality sources, including peer-reviewed studies, to support the facts within our articles. 7, no. Reactions to metals in knee replacements happen when the immune system overreacts or launches a defensive assault on the artificial joint and surrounding tissues, triggering local inflammation. Also, more complex immune reactions may develop around the implants,. Metals including titanium can form haptenic antigens in their ionic form upon bonding with human cell native proteins and have the ability to potentiate degranulation of basophils and mast cells [3]. In our case, the patients nonspecific symptoms due to the titanium clips were quite different from the symptoms reported in other studies and may not wholly be attributable to titanium hypersensitivity since the patient had known allergic reactions to various other allergens as well. Moreover, the patient was under multiple specialists care and had many hospitalizations and a history of various medication intake, including antibiotics and painkillers. Adhesive allergy; Contact dermatitis; Joint failure; Joint replacement; Metal allergy; Methyl methacrylate; Nickel; Rash; Surgical implant. This can cause mild to significant local discomfort. Dermatitis. Biologic reactions to these screws have been shown to include pretibial cysts . DHT is typically diagnosed by excluding all other causes of post-operative knee pain, such as: It is only after these causes are excluded that metal sensitivity is explored. Would you like email updates of new search results? Patch testing is the gold standard to determine sensitization, and this review provides a list of standard allergens to test for different implants. 145162, 2008. Click to share on Facebook (Opens in new window), Click to share on Twitter (Opens in new window), Click to share on LinkedIn (Opens in new window), Click to email a link to a friend (Opens in new window), Two Level Cervical Disc Replacement (Mobi-C). 2023 Mar 20;16(6):2463. doi: 10.3390/ma16062463. *List is not exhaustive. Based on the level and proportion of immune cells in the sampleincluding leukocytes, eosinophils, and basophilsthe healthcare provider can diagnose DHT with a relatively high degree of confidence. Joint aspiration (in which fluids are extracted from the joint compartment) can be used to obtain and evaluate the composition of immune cells in the knee fluid sample. There is also tissue response to implants, such as the hyperplastic lesions of the soft tissues. Health care providers have been known to rely more on staples in performing surgeries. According to the U.S. Food and Drug Administration, some of the most common surgical staple and stapler malfunctions reported to the regulating agency include a malformed staple, failure of the stapler in firing the staple, misfiring, application of the staples to wrong tissue, and a surgeon applying the wrong size of staples to a tissue. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. This causes type IV hypersensitivity reaction through sensitization of T lymphocytes and macrophages. official website and that any information you provide is encrypted Metal allergies are becoming more recognized within the surgical field. V. Vijayaraghavan, A. V. Sabane, and K. Tejas, Hypersensitivity to titanium: a less explored area of research, J Indian Prosthodont Soc., vol. Edina, However, in chronic cases of months to years after the operation, a CT scan is usually performed to rule out malignant tumors and possible fistula formations [13]. can be made from various materials, such as: The brief answer to our initial question is yes, patients can be allergic to hardware if they have a pre-existing allergy to the materials that make up the hardware (titanium, stainless steel, etc.). The patient started having another episode of intermittent right lower quadrant (RLQ) pain starting in January 2020. We thank Dr. Guirguis, Department of Radiology, and Williamson Medical Center for their contributions in this case report. The woman also had a cholecystectomy back in 2007, and thats when she began experiencing symptoms including joint pain and tenderness, cramps, dry skin and hair, racing heart, hand tremors, and high blood pressure, among many others. Healthcare providers now believe that the term, "iodine allergy" should no longer be used because it is inaccurate.

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