Bone cement, which is a methyl methacrylate, is another concern. Stainless steel contains nickel, chromium, and manganese in varying percentages and may also contain molybdenum. The most common implants used are composed of cobalt/chromium that contains molybdenum and a small amount of nickel.
That said, the highest frequency of responses we find are to nickel, cobalt, and chromium, with less frequent reactions to manganese and molybdenum. We typically patch test to all the metals known to be included in orthopedic implants, but I worry that we have few responses to many of them because the extracts aren’t sensitive, and not because the responses are true negatives.
However, many of the extracts available have not been validated against any other standard. "Patch testing remains the best method of identifying type IV ‘allergic’ T cell based responses. I asked Karin Pacheco MD, MSPH, FAAAAI, for her expertise on this issue. These are all individualized pastes, and there is no Pre-Prepared patch testing sheets, like a "Tru-Test" panel that would ease the logistical problems of placement.Ĭan you recommend a specific edited list of antigens that would best serve to screen these patients if we elect to do patch testing, to minimize the patient’s financial burden, and ease the logistical burden on us in placing the tests? I also understand that "Smart Practices/Canada" offers acceptable patch test reagents for "metal components, and implant cement components" but unfortunately after contacting the company I was given a list of over 40 reagents that could be utilized in the placement. I understand the limitations and uncertainty that Patch testing offers patients who request "metal and chemical component patch testing" if they are experiencing joint inflammation following joint implant surgery, or if they are concerned that the "nickel sulphate" contact dermatitis might place them at risk for implant failure after placement. Question regarding the best reagents to patch test with for metal component patch testing.
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