Material Hypersensitivity and Alloplastic TMJ Replacement

Publication date: Available online 7 February 2019

Source: Journal of Oral and Maxillofacial Surgery

Author(s): L.G. Mercuri, M.S. Caicedo

Abstract

Purpose

There appears to be little consensus on how to evaluate and manage patients reporting a possible allergic reaction to joint replacement devices containing metal. This paper will analyze the current orthopedic literature in this regard as it relates to diagnosis, testing and management. Based on that evidence, a management algorithm for metal hypersensitivity in the alloplastic TMJ replacement patient is proposed.

Materials and Methods

Orthopedic surgery has recognized metal sensitivity as a problem in joint replacement; using a PubMED search for this topic, the pertinent orthopedic literature was reviewed.

Results

Metal hypersensitivity response to implant materials is often a diagnosis of exclusion. The two most commonly used tests are the in vivo skin patch test and in vitro lymphocyte transformation test. Initially, conservative management is indicated while other more common causes of symptomatic total joint replacement should be fully explored. Device removal should be considered as a last resort.

Conclusions

Prior to a primary total joint replacement, testing may be helpful when a patient reports a history of intolerance to jewelry or of an allergic reaction to a prior metal implant. However, to date, routine testing is not supported by the literature.

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