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首页> 外文期刊>Allergy >Increased metal allergy in patients with failed metal-on-metal hip arthroplasty and peri-implant T-lymphocytic inflammation.
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Increased metal allergy in patients with failed metal-on-metal hip arthroplasty and peri-implant T-lymphocytic inflammation.

机译：金属对金属髋关节置换术失败和植入物周围T淋巴细胞炎症患者中金属过敏的增加。

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BACKGROUND: In 16 patients with revised metal-on-metal arthroplasty and peri-implant lymphocytic inflammation, we verified the role of metal hypersensitivity by patch testing (PT) and lymphocyte transformation test (LTT). METHODS: In the 16 patients with lymphocyte dominated periprosthetic inflammation, allergy history was obtained by a questionnaire, specific serum IgE to aeroallergens was measured to assess atopy, PT to standard and metal series was performed and metal sensitivity was further assessed by LTT using blood mononuclear cells. RESULTS: Revision surgery was performed because of pain (8/16), osteolysis (4/16), dislocation (3/16) and loosening of the stem (1/16). Histological examination showed perivascular infiltrates of T lymphocytes, high endothelial venules, fibrin exudation and accumulation of macrophages with drop-like inclusions. Five patients had a history of cutaneous metal allergy and atopy was found in 25% of the patients. In 13/16 patients (81%), systemic metal sensitivity was found based on PT and/or LTT. Patch test reactions were seen in 11/16 patients (69%; partly multiple reactions/patient): 7/16 to Cobalt (Co), 7/16 to Chromium (Cr), 4/16 to Nickel (Ni), and one each to Molybdenum (Mo) and Manganese (Mn). Ten of 16 patients (62%) showed enhanced LTT reactivity to metals: 7/16 to Ni, 7/16 to Co, 5/16 to Cr, 5/16 to Mo and 4/16 to Mn. CONCLUSIONS: The lymphocyte dominated peri-implant inflammation may well reflect an allergic hyper-reactivity in these patients, given the high rate of concomitantly found metal allergy. Despite the overall incidence of metal implant allergy being low, allergic reactions should be included as differential diagnosis in failed metal-on-metal arthroplasty.
机译：背景：在16例金属对金属置换术和植入物周围淋巴细胞炎症改良的患者中，我们通过斑贴试验（PT）和淋巴细胞转化试验（LTT）验证了金属超敏反应的作用。方法：对16例以淋巴细胞为主的假体周围炎症患者，通过问卷调查获得过敏史，测量针对气敏原的特异性血清IgE来评估特应性，对标准品和金属系列进行PT评估，LTT使用血液单核进一步评估金属敏感性细胞。结果：因疼痛（8/16），骨溶解（4/16），脱位（3/16）和茎干松动（1/16）而进行了翻修手术。组织学检查显示T淋巴细胞的血管周围浸润，高内皮小静脉，纤维蛋白渗出和巨噬细胞积聚，呈滴状包裹体。 5名患者有皮肤金属过敏史，25％的患者发现特应性过敏。在13/16例患者（81％）中，基于PT和/或LTT发现全身金属敏感性。在11/16患者中发现了斑贴试验反应（69％;部分/患者为部分多种反应）：钴（Co）为7/16，铬（Cr）为7/16，镍（Ni）为4/16，其中一分别是钼（Mo）和锰（Mn）。 16名患者中有10名（62％）表现出对金属的LTT反应性增强：对Ni的7/16，对Co的7/16，对Cr的5/16，对Mo的5/16和对Mn的4/16。结论：鉴于伴随金属过敏的发生率很高，这些以淋巴细胞为主的植入物周围炎症可能很好地反映了这些患者的过敏性高反应性。尽管金属植入物过敏的总体发生率较低，但应将过敏反应作为鉴别失败的金属对金属置换术的鉴别诊断。

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