On the other hand, another rare case of a female patient was also the topic of one case report. Save my name, email, and website in this browser for the next time I comment. Metal Hypersensitivity After Spinal Instrumentation: When to Suspect Our case is about a 28-year-old female presenting with a spectrum of abdominal symptoms with a complicated medical history. 2000 Jul;43(1):35-40 Medicines to avoid in pregnancy In general, allergic risk of titanium material is smaller than that of other metal materials. Front Immunol. Moreover, the patient was under multiple specialists care and had many hospitalizations and a history of various medication intake, including antibiotics and painkillers. 639644, 2020. Diagnosing any metal allergy, including titanium allergy, has been complicated by various tests sensitivity and specificity. We discuss the presentation, investigations, and treatment of this unusual case. Health care providers have been known to rely more on staples in performing surgeries. Rushing GD, Goretsky MJ, Gustin T, Morales M, Kelly RE Jr, Nuss D. J Pediatr Surg. Surgical exploration, revision to LCS prosthesis with bone graft and PMMA cement. The patient started having another episode of intermittent right lower quadrant (RLQ) pain starting in January 2020. 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). However, in some patients, hardware can become prominent or irritate a nearby . The delayed hypersensitivity occurs due to the natural corrosion of metals over time. No difference in positive patch-test results between restenosis and nonrestenosis groups after stent implantation (9% vs 10%). Please enable it to take advantage of the complete set of features! Hay fever, also called allergic rhinitis, can cause . You also have the option to opt-out of these cookies. A perfectly functioning dynamic implant causing no pain and without evidence of loosening should not be removed in most cases, despite a positive patch-test result. Copyright 2021 Molly S. Jain et al. Symptoms reported have included: Having a skin sensitivity to a particular metal is not thought to correlate well to having sensitivities to implanted metals. official website and that any information you provide is encrypted Erythema, swelling, sterile effusions, pain with limitation of movement. apr18 1, article bcr2013009070, 2013. 2022 Dec 22;16(1):115. doi: 10.3390/ma16010115. Diagnostic laparoscopy evaluation with fluoroscopic guidance was performed to locate the exact positioning of the pigtail catheter within the cecum before surgery (a) and after pigtail catheter removal (b). Staged revision resulted in pain relief, but nerve palsy did not recover. Titanium: a review on exposure, release, penetration, allergy, epidemiology, and clinical reactivity. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams. 5761, 1999. Patch-tested at time of stenting and again in 6 mo; 6.9% were nickel allergic, but 37% developed instent restenosis; 1/3 nickel-allergic patients developed diffuse in-stent restenosis. Adhesive allergy; Contact dermatitis; Joint failure; Joint replacement; Metal allergy; Methyl methacrylate; Nickel; Rash; Surgical implant. Most skin reactions are eczematous and allergic in nature, although urticarial, bullous, and vasculitic eruptions may occur. Spinal hardware (screws, plates, rods, etc.) Metal hypersensitivity reactions to orthopedic implants. Accessibility 2022 Nov 28;13:1050315. doi: 10.3389/fimmu.2022.1050315. -, Lancet. 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. Cite this: Cutaneous and Systemic Hypersensitivity Reactions to Metallic Implants-Medscape-Apr01,2011. Would you like email updates of new search results? In most cases, patients have no issues with the hardware. 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. In general, orthopedic implants are alloys, meaning they contain more than one type of metal. Kohal RJ, Burkhardt F, Chevalier J, Patzelt SBM, Butz F. J Funct Biomater. 2023 Feb 2;11:1140393. doi: 10.3389/fbioe.2023.1140393. 145162, 2008. The patient recovered well with no significant intraoperative or postoperative complications. and transmitted securely. 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. Nickel, cobalt, and chromium are the three most common metals that elicit both cutaneous and extracutaneous allergic reactions from chronic internal exposure. It is mandatory to procure user consent prior to running these cookies on your website. Disclaimer. Commenting is limited to medical professionals. By clicking Accept, you consent to the use of ALL the cookies. Accessibility 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. 201207, 2012. Lump in left groin associated with shooting pain, Bilateral MOM hip resurfacings (34 mo apart). Martinez JS, Peterson S, Hoel CA, Erno DJ, Murray T, Boyd L, Her JH, Mclean N, Davis R, Ginty F, Duclos SJ, Davis BM, Parthasarathy G. PLoS One. Iodine Allergy: What You Should Know - Verywell Health Rare Systemic Response to Titanium Spinal Fusion Implant: Case Report Revision to titanium alloy with ceramic-on-ceramic bearing led to symptom resolution. In orthopedic joint surgery, reported metal hypersensitivity reactions include cutaneous rash and erythema to joint pain and aseptic implant loosening [10] . The use of sutures are said to be beneficial in laparoscopic or robotic assisted cholecystectomies. ALVAL = aseptic lymphocytic vasculitisassociated lesions; Co = cobalt; Cr = chromium; CT = computed tomography; F = female; M = male; MOM = metal-on-metal; Ref. HSS J. doi:10.1007/s11420-018-9614-8, Mayer AS, Erb S, Kim RH, et al. Pigtail plastic stents are used to remove the intra-abdominal drainage during procedures such as endoscopic retrograde cholangiopancreatography (ERCP) [8]. Yabit F, Hughes L, Sylvester B, Tiesenga F. Cureus. This resulted in approximately 75lbs. Unauthorized use of these marks is strictly prohibited. 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. A rash after surgery may be due to contact with irritants or an allergic reaction to a medication. eCollection 2023. In other words, an orthopedic surgeon has to first exclude the more likely causes of continued pain or swelling around an implant such as infection, instability, implant loosening or tendinitis before considering hypersensitivity associated with an implant. Dermatol Ther (Heidelb). Vomiting or diarrhea. or can an allergic reaction occur from these - Answered by a verified Doctor . They may want to consider an implant made of different materials, such as titanium. By Jonathan Cluett, MD The patients social history is insignificant, with no smoking or alcohol consumption. 97100, 2017. These allergens are also the most important in reactions to spinal surgeries. Patient-ReportedMetalAllergy: A Risk Factor for Poor Outcomes After Total JointArthroplasty? Its symptomsitching, knee pain, skin rashes, joint stiffness, and swellingcan also have other causes, which makes this difficult to diagnose. Summer B, Lill D, Remmel K, Schraml A, Schopf C, Banke IJ, Kuechenhoff H, Maierhofer T, Endres S, Thomas P. Front Immunol. It may be necessary to remove the spinal hardware to avoid any further complications. Read our. In an aging population, the putative association between metal allergy and device failure due to DTH may be a problem of growing significance. Jonathan Cluett, MD, is a board-certified orthopedic surgeon with subspecialty training in sports medicine and arthroscopic surgery. Stainless steel screws are commonly used for internal fixation in an array of podiatric procedures. The pigtail catheter in the cecum was removed carefully, and the foreign body was measured 10.0cm in length and 0.3cm in diameter. Verywell Health's content is for informational and educational purposes only. Whether a similar sensitivity may develop to metal implanted inside the bodywhere it doesn't touch the skinisn't yet well understood, but there is some evidence it can happen. This site needs JavaScript to work properly. eCollection 2022 Jun. Nasal congestion. 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. It may be necessary to remove the spinal hardware to avoid any further complications. Retained foreign bodies (RFB) are also possible complications of any surgical procedure. A hidden threat for dental implant patients? July 9, 2021/ Erica Davies / Surgical Stapler Lawsuit / 0 comments. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. Implants made from titanium, ceramic, and coated parts are considered safe for people with metal allergies and unlikely to cause a reaction. This may not always be possible, and an implant made with nickel may be the most appropriate implant available for your condition. Also, more complex immune reactions may develop around the implants,. Eczema most severe around the implant site, 3. After the diagnosis of RFB, the preferred approach is to remove the RFB laparoscopically [13]. The https:// ensures that you are connecting to the With that said, some studies suggest that they may be beneficial for certain groups. Despite repeated attempts by researchers and clinicians to further understand this difficult area of medicine, the association between metal sensitivity and cutaneous allergic reactions remains to be fully understood. He exhibited allergic symptoms (eczema) after orthopedic surgery. Biomaterial scaffolds regulate macrophage activity to accelerate bone regeneration. Metal allergic patients, screened before receiving stainless steel orthopedic implants. After removal of dental implants, the eczema disappeared completely. Absence of other contact allergens or systemic cause, 4. document.getElementById( "ak_js_1" ).setAttribute( "value", ( new Date() ).getTime() ); Your Injury:Bladder SlingGadolinium (MRI)Hernia MeshIVC filterNuVasive MAGECParagardStryker HipSurgical StaplerTransvaginal Mesh------AbilifyActosAduhelmBelviqCymbaltaEffexorElmironEssureGranufloDepakoteGeodonInvegaInvokanaLyricaNexiumOpioidsParaquatRisperdalRoundupTestosterone therapyTalcum PowderTaxotereXareltoZantacZofranZoloftZinbryta, State:AL AlabamaAK AlaskaAZ ArizonaAR ArkansasCA CaliforniaCO ColoradoCT ConnecticutDE DelawareFL FloridaGA GeorgiaHI HawaiiID IdahoIL IllinoisIN IndianaIA IowaKS KansasKY KentuckyLA LouisianaME MaineMD MarylandMA MassachusettsMI MichiganMN MinnesotaMS MississippiMO MissouriMT MontanaNE NebraskaNV NevadaNH New HampshireNJ New JerseyNM New MexicoNY New YorkNC North CarolinaND North DakotaOH OhioOK OklahomaOR OregonPA PennsylvaniaRI Rhode IslandSC South CarolinaSD South DakotaTN TennesseeTX TexasUT UtahVT VermontVA VirginiaWA WashingtonWV West VirginiaWI WisconsinWY WyomingOther. 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. 2008 Jan;37(1):75-88. doi: 10.1007/s00132-007-1183-3. Epub 2018 Apr 16. While the words "hypersensitivity" and "allergy" are often used interchangeably, they're not really the same. Fortunately, people who's implant problems were a clear result of metal sensitivity usually find immediate relief after removal. When you visit the site, Dotdash Meredith and its partners may store or retrieve information on your browser, mostly in the form of cookies. Bioact Mater. Allergic or sensitive to metal? It explores the causes and symptoms of a reaction and what to do if you suspect one. "it appears that most patients who are metal-sensitive can safely receive an orthopedic implant containing that metal without the risk of cutaneous or systemic complications. Regardless of all these factors, surgeons and clinicians must have a high clinical suspicion of RFB and appropriate diagnostic imaging for diagnosis and removal of the RFB. J Prosthet Dent. She was diagnosed with pneumonia twice followed by two sinusitis episodes from January 2020 to March 2020. The PubMed wordmark and PubMed logo are registered trademarks of the U.S. Department of Health and Human Services (HHS). Dizziness or fainting. Bethesda, MD 20894, Web Policies If you have any of these symptoms, you may wish to speak to a doctor to discuss the possibility of having hypersensitivity reactions. Still, cases have been reported, and some people's symptoms have gone away after removal. Having a metal allergy or sensitivity doesn't mean getting a metal implant like a surgical screw, plate, or joint replacement is entirely off limits or that the body will reject it. Titanium hypersensitivity - MELISA The site is secure. The striking features of titanium include its stability with increased resistance to corrosion and its biocompatibility to diverse materials [3]. Titanium is extensively used in devices such as dental implants, pacemakers, and body piercing. M. Hosoki, K. Nishigawa, T. Tajima, M. Ueda, and Y. Matsuka, Cross-sectional observational study exploring clinical risk of titanium allergy caused by dental implants, Journal of Prosthodontic Research, vol. Keywords: Verywell Health's content is for informational and educational purposes only. All material on this website is protected by copyright, Copyright 1994-2023 by WebMD LLC. Symptoms controlled with repeated joint aspirations. government site. 8600 Rockville Pike RFB should be included in the differential diagnoses when the patient presents with acute reactions after surgical procedures. On November 5, 2020, the embedded right colon foreign body was identified with fluoroscopic guidance (Figures 3(a) and 3(b)) and removed surgically (Figure 4). Cutaneous reactions to metal implants, orthopedic or otherwise, are well documented in the literature. Revision to conventional THR led to resolution of pain. The patients preop white blood cell (WBC) count was 5.2K/L, absolute neutrophil count was 3281 cells/L, and absolute lymphocyte count was 1284 cells/L. All of which have resulted in complications that may either occur during the surgical procedure, or may only show up days after the surgery. Symptoms reported have included: 3 Anemia Weakness Numbness Pain Having a skin sensitivity to a particular metal is not thought to correlate well to having sensitivities to implanted metals. There are more than 28 million surgical procedures with up to 1500 cases of retained foreign bodies estimated in the United States per year [13]. Allergic reactions occur when a substance triggers an immune response. 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. Painful Hardware - FootEducation The base metals are found in the highest quantities, but smaller amounts of other metals, such as nickel and aluminum, are often used. It requires a case-by-case evaluation weighing the potential benefits and risks. High resolution DLP stereolithography to fabricate biocompatible hydroxyapatite structures that support osteogenesis. This requires immediate attention and an X-ray for further investigation. However, many of the materials that provide stability, flexibility, and durability to the implants are also immunogenic. The abdominal pain is associated with titanium allergy reaction from previously inserted titanium-based surgical clips. Hypersensitivity Reactions to Metallic Implants Hypersensitivity or allergy can occur after contact with various metals. There is no data to support the routine use of ceramic (zirconium) or titanium implants, even in people with concerns about metal hypersensitivity. PMC If a glass of milk or slice of pizza causes swollen lips, hives, or other symptoms, you may have an allergy to casein, a protein in milk. 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. Finally, the blood test could be effectively used to diagnose type IV hypersensitivity allergic reactions, including contact dermatitis or eczema reported by few studies on titanium allergy [12]. *List is not exhaustive. discharge. To confirm, the patient was further ordered for memory lymphocyte immunostimulation assay (MELISA) that also showed equivocal results for titanium allergy. Presenting symptoms are related to intolerance of the implant and include persistent or recurrent pain, skin reactions, edema, and hardware failure or loosening. Most skin reactions are eczematous and allergic in nature, although urticarial, bullous, and vasculitic eruptions may occur. In essence, hypersensitivity reactions become a diagnosis of exclusion for physicians. A decision was made to remove all the metal surgical clips laparoscopically via fluoroscopic guidance (Figure 1). 66/92 had symptoms (pain, reduced motion, swelling). While the potential for a reaction exists, it's thought to be extremely low. MeSH You can find out more about our use, change your default settings, and withdraw your consent at any time with effect for the future by visiting Cookies Settings, which can also be found in the footer of the site. You will receive email when new content is published. An official website of the United States government. This is why it is important to exclude all other causes of joint inflammation and pain before exploring the next step in treatment: revision surgery. The titanium screws used in the orthopedic surgery that he underwent were removed 1 year later, but the eczema remained. The first case of a dermatitis reaction over a stainless steel fracture plate was described in 1966. The CT impressions showed no signs of bowel obstruction or colitis; however, it was evident that a portion of a pigtail drainage catheter was lodged within the cecum (Figure 2). 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]. Proper history taking, appropriate physical exams, and specific diagnostic modalities can identify rare causes of chronic abdominal pain. Most of the usage of titanium is in the form of titanium dioxide. Titanium a strong metal that is known to hold fast to tissues and bone and tends to cause few problems for patients in surgeries. In the following years, the patient went through an ERCP procedure multiple times due to her sphincter of Oddi dysfunction followed by laparoscopic rectopexy for a rectal prolapse. Titanium has been considered to be a non-allergenic material. Allergy to a metal screw is very rare, so consider other issues first. The information contained herein is subject to change without notice. Nickel is one of the most common allergens, and can cause local contact dermatitis characterized by itching and skin reddening. An allergic reaction can crop up in the form of headaches, pain in the back and extremities, fever, and other symptoms. official website and that any information you provide is encrypted 2019 Nov;10:02758. doi:10.3389/fimmu.2019.02758, Faschingbauer M, Renner L, Boettner F. Allergy in total knee replacement. Can the human body reject surgical screws used to repair Patient satisfaction after total knee replacement: a systematic review. An interleukin-1 polymorphism additionally intensified by atopy as prognostic factor for aseptic non-mechanical complications in metal knee and hip arthroplasty. This website also contains material copyrighted by 3rd parties. Unfortunately, the symptoms of metal implant sensitivity and allergy are not well defined. Effects of Excimer Laser Treatment of Zirconia Disks on the Adhesion of L929 Fibroblasts. The CT scan showing a portion of the pigtail catheter lodged within the cecum in a coronal view (a), sagittal view (b), and axial view (c). 2022 Oct 24;14(10):e30625. Careers. Titanium is another type of metal that is utilized extensively in cardiac pacemakers, dental procedures, arthroplasty, body piercing, and spectacle frames [2]. 1, pp. -, Lancet. Especially, in our case, the patients extensive past medical history and multiple overlapping medical conditions delayed her diagnosis of RFB and caused her significant life distress. This category only includes cookies that ensures basic functionalities and security features of the website. Read the article to learn more about what triggers this side effect and how you can ask help from your doctor to avoid any complications after your surgery. A number of studies also suggest a conversion to suturing in place of surgical stapling in order to avoid allergic reactions and other potential complications after surgery. Painful cramps. The patient contacted our department the next morning, and the case and CT findings were reviewed. 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.). In September 2020, the patient went to a walk-in clinic due to urinary tract infection (UTI) symptoms and was prescribed a course of cephalexin which resolved the infection. As these cases are reported with metal implants including clips used in surgery, these allergic reactions can also be expected with staples. Thank you, {{form.email}}, for signing up. Spinal fusion and disc replacement metal hypersensitivity reactions were reported as an initial pain-free interval with delayed persistent pain. Telephone: 1.800.234.1826 Nickel allergy to orthopaedic implants: A review and case series She had to be hospitalized with strict isolation to wait for her medication regimen to work along with the infusion of IV fluids. The patient did not report any screening for immunodeficiency in the past. M. Little, P. C. Munipalle, and O. Nugud, A rare late complication of laparoscopic cholecystectomy, Case Reports, vol. This causes type IV hypersensitivity reaction through sensitization of T lymphocytes and macrophages. The catheter was removed surgically which resolved the patients RLQ abdominal pain and accompanying symptoms. Some potential symptoms of sinusitis include: pain, tenderness, or swelling around the cheeks, eyes, or forehead green or yellow nasal mucus a blocked nose a reduced sense of smell sinus. Middleton S, Toms A. Dental implants; Metal allergy; Orthopedic surgery; Patch testing; Titanium. Any cookies that may not be particularly necessary for the website to function and is used specifically to collect user personal data via analytics, ads, other embedded contents are termed as non-necessary cookies. Co-Cr-Mo = cobalt-chromium-molybdenum; LCS = low contact stress; MOM = metal-on-metal; PMMA = polymethylmethacrylate; pts = patients; Ref. Nickel-stented patients: difference in restenosis rate between "allergic patients with restenosis (. Biologic reactions to these screws have been shown to include pretibial cysts . 3, pp. Juliana L. Basko-Plluska, Jacob P. Thyssen, and Peter C. Schalock Jonathan Cluett, MD, is board-certified in orthopedic surgery. 35, no. All of her symptoms were initially suspected due to the infections mentioned above, and she was placed on various antibiotic therapy regimens consisting of ciprofloxacin, amoxicillin/clavulanate potassium, and sulfamethoxazole/trimethoprim. The skin patch test has not yet been developed as the valid standardized test for titanium allergy. A pigtail catheter is a universal drain used to remove fluids or abscesses from organs, ducts, or body cavities. 2013 ;55(1-3):83-90. doi:10.1007/s12026-012-8351-1, Schoon J, Ort MJ, Huesker K, Geissler S, Rakow A. Please confirm that you would like to log out of Medscape. W. S. Towers and K. Kurtom, Rare systemic response to titanium spinal fusion implant: case report, Cureus, vol. The case also unfolds rare differential diagnoses to keep in mind when encountering a patient with abdominal pain and associated nonspecific symptoms. 6, p. 630, 2014. He exhibited allergic symptoms (eczema) after orthopedic surgery. Allergic reactions can range from mild to severe. Titanium Rejection Symptoms | Colgate Red, swollen, watery eyes -- a condition known as allergic conjunctivitis. Titanium has also been reported as an allergen in a few studies, causing type I or type IV hypersensitivity reactions [3]. However, several studies have reported cases of metal allergy caused by titanium-containing materials. The patient has been recommended to do a close follow-up for a few months to monitor her progress. When they do occur, however, the associated pain, swelling, inflammation, and decreased range of motion can significantly impair the implant function. eCollection 2022. Infrequent complications have been discussed in studies regarding pigtail catheter found on computerized tomography (CT) scan following a procedure. Metal allergies and sensitivities can be assessed using skin patch testing. Popiolek I, Blasiak M, Kozak A, Pietak E, Bulanda M, Porebski G. Diagnostics (Basel). Signs and symptoms of metal hypersensitivity can range from mild to severe and generalized. We describe a case of chronic abdominal pain, which is potentially complicated by retained titanium surgical clips and subsequently a retained portion of a pigtail catheter. The Opioid Epidemic. Implantation of cross-linked polyethylene bearing surface led to symptom resolution in 3 mo. More surgical procedures are closed using skin glues, which are also capable of triggering a blistering contact dermatitis. Disclaimer. Rates of allergy: nickel, patients (24.2%); cobalt, 6.1%; chromium, 3.0, Symptomatic patients (31.8%) showed an allergic reaction to bone cement components (gentamicin 23.8%, benzoyl peroxide 10.6%, hydroquinone 4.5%), Sensitization rates in symptom-free patients: 3.8% for nickel, cobalt, chromium; 15.4% for gentamicin, 37-year-old female s/p fracture of right wrist, Reduction and insertion of vitallium plate, Oozing, irritation around scar initially, then extended to right forearm and hands, Osteotomy with insertion of vitallium plate and screws, Topical therapy unsuccessful; rash resolved after plate and screws removed, Sherman plate (stainless steel alloy Al316), Rash resolved within 1 mo of hardware removal, Intramedullary nail (stainless steel alloy Al316), Rash resolved within 15 days of hardware removal, Osteosynthesis with screw (stainless steel alloy Al316), Topical therapy unsuccessful; rash resolved within 1 mo of hardware removal, Surgical realignment, metal plates & screws (made of Fe, Cr, Ni), Rash improved with hardware removal, but quickly relapsed, Ongoing eczema due to remaining metal fragments after plate removal, PCA prostheses (4 hip, 1 knee, 1 patella removal), Left-leg prosthesis (acrylic cement) and potassium dichromate, Eczema completely resolved after prosthesis removal, Positive for certain allergens in the acrylic cement and for potassium dichromate, TKA with metal-onplastic prosthesis (Co-Cr alloy), Eczematous reaction while being treated with antibiotics, Open reduction and internal fixation with vitallium plate and screws, Urticaria completely resolved within 3 days of hardware removal, Eczema resolved within 2 mo of revision to zirconium-niobium alloy prosthesis, Total knee replacement with condylar knee, 48 F with bilateral OA and allergy to Ni and Co, Eczematous dermatitis that became generalized, Skin findings managed with topical steroids, with good response, Bilateral hip pain, intermittent lowgrade fever, Pain at time of surgery; persistent for 3 yr. Exchange of metal liner with cross-linked polyethylene liner led to resolution of pain and fever within 8 mo.