Do you have anything on the effects of possible patient allergic
reactions to the metal nickel, a component of the prostheses that are
used in total knee replacements?

I presume that you, like me, are not a medical expert, and that you
are looking for reputable web pages on this issue which are directed
to the general public.  I have found several such web pages.  Each
indicates that there is at least some possibility of an allergic
reaction to a prosthesis containing nickel.

A case study on materials for total hip replacement notes that "some
people may develop an allergic reaction to the nickel content" of
stainless steel implants.
"Case Study of Materials Selection for Total Hip Replacement" (section
on "A Charnley stainless steel implant")
Queen Mary, University of London, Department of Materials
http://www.materials.qmul.ac.uk/casestud/implants/

A doctor at an orthopedic and sports medicine clinic writes that
"between 3-8% of the population are allergic to nickel."  This doctor
indicates that orthopedic surgeons might choose a zirconium-alloy knee
replacement for nickel-sensitive patients.
"Oxidized Zirconium for Total Knee Replacement," by William Schreiber,
M.D.
Azalea Orthopedic & Sports Medicine Clinic: What’s New
http://www.orthopedicspecialists.com/news.html

The Hospital for Special Surgery (HSS) states that "patients with
severe allergic reaction to nickel were unable in the past to receive
total knee prostheses."  The HSS indicates that a "ceramic knee" (or
more technically an "oxidized ceramic surface zirconium alloy
implant") can be safely used for such patients.
"New Total Knee Replacement Available"
Hospital for Special Surgery: HSS News
http://www.hss.edu/news/newsdetail.asp?NewsID=6

But before you conclude that there is definitely a significant risk of
allergic reaction to nickel, consider this last web page.  An
orthopedic surgeon writing on the Arthritis Foundation web site
asserts that it is "highly unlikely" for someone to develop an allergy
to the metal in a joint prosthesis.  He states that in "rare cases
people have developed an allergy or reaction to certain metals used in
joint implants, but it is not clear exactly what percentage of the
population may have such sensitivities.  Also, there is debate about
the consequences of a metal sensitivity in these instances."  Still,
this doctor recommends that a patient who suspects a sensitivity to
nickel or titanium to discuss the issue with his or her surgeon.
"Artificial Joint Allergies," by Jeffrey Nugent, MD, Orthopaedic
Surgeon
Arthritis Foundation: Arthritis Today: The Best of "On Call": Archive
- Part 2
http://www.arthritis.org/resources/arthritistoday/OnCall_part2.asp#27

So this is probably the best last word: if you are considering
knee-replacement surgery, and are worried about a reaction to nickel,
discuss your concerns with the surgeon.

I hope that this is helpful.

- justaskscott-ga


Search terms used on Google:

allergy nickel prosthesis
allergy nickel prostheses
allergic nickel prosthesis
allergic nickel prostheses
allergy nickel "knee replacement"
allergic nickel "knee replacement"

---

Clarification of Answer by justaskscott-ga on 25 Jun 2002 19:55 PDT

I misread the question when I answered it -- you asked about "the
effects of possible patent allergic reactions," and I answered only
about the possibility of allergic reactions.  So you are certainly
entitled to a clarification.

I should make sure that I know specifically what you want.  Are you
interested in both how the possibility of an allergy is determined and
how an allergic reaction might affect the sufferer?

---

Clarification of Answer by justaskscott-ga on 30 Jun 2002 08:41 PDT

I'm assuming from your initial question and from your rating that you
are interested in both the determination and the effects of nickel
allergy.  In both cases, it seems that the answer is very
straightforward.

It appears that the standard way to determine whether a patient has a
nickel allergy is through patch testing.  For details, see:

"Patch Testing for Skin Allergies," by Dr. Virginia Hubbard and Dr.
Malcolm Rustin
NetDoctor.co.uk 
http://www.netdoctor.co.uk/health_advice/examinations/patchtesting.htm

"Nickel Allergy" (Jan. 31, 1997)
Go Ask Alice: Columbia University’s Health Question and Answer
Internet Service
http://www.goaskalice.columbia.edu/1083.html

"Metal Allergy discussion, Totally Hip, April 2001" (posting by
SJHimel)
Hip Universe
http://hipuniverse.homestead.com/files/metaler.htm

And it appears that the most common allergic reaction to nickel in
prosthesis or implants is a tissue reaction or inflammatory reaction
(which I assume are the same thing).

"Hip Replacement: During the Operation"
MEM-CED Patient Forum
http://www.orthoglobe.com/cm/pfsp_na_focus_start/pfsp_na_jointrep/pfsp_na_jointrep_hip_during_surgery?sid=%3C!WEM_REQUEST.sid%3E

"Guidance Document for Nickel in Shellfish," section on "Hazard
Assessment" (1993)
U. S. Food and Drug Administration, Center for Food Safety & Applied
Nutrition
http://vm.cfsan.fda.gov/~frf/guid-ni.html

And if you want more resources on nickel allergy, check out the
following collection of links:

"Nickel Allergy"
About.com: Allergies
http://allergies.about.com/cs/nickel/

- justaskscott-ga


Additional search term used on Google:

implants

I like what you've said, as far as you've said it.  However, I'd like
to hear a little bit more about nickel allergies: how they're
determined, etc.  Thanks