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What role does metal allergy sensitization play in total knee arthroplasty revision?

Overview of attention for article published in Journal of Experimental Orthopaedics, August 2018
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1 tweeter
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3 Facebook pages

Citations

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1 Dimensions

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15 Mendeley
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Title
What role does metal allergy sensitization play in total knee arthroplasty revision?
Published in
Journal of Experimental Orthopaedics, August 2018
DOI 10.1186/s40634-018-0146-4
Pubmed ID
Authors

David R. Lionberger, Justin Samorajski, Charlie D. Wilson, Andreana Rivera

Abstract

Clinicians are often faced with the decision whether to revise a painful total knee replacement in patients who have chronic vague pain with no apparent explanation. A sensitive metal testing assay called the lymphocyte stimulation test has been used to detect nickel sensitization in patients with orthopedic implants. We hypothesize that nickel sensitization plays a role in the pathology of failed joint arthroplasty in patients with unexplained dissatisfaction. 32 patients with symptomatic total knee arthroplasty without obvious mechanical findings were tested prior to revision surgery. 19 nickel-sensitized and 13 non-sensitized patients were compared by cell counts of synovium surgical specimens for CD4+ and CD8+ cell lines. Patients were then revised with ceramic-coated implants. Secondary evaluation of functional outcomes, range of motion, and pain relief were assessed. Nickel-sensitive patients showed a statistical increase in CD4+ reactivity compared to CD8+ reactivity. The ratio of CD4+/CD8+ T lymphocytes was 1.28 in nickel-sensitive patients versus 0.76 in the control (p = 0.009). There was no difference in functional scores, clinical scores, or range of motion after revision. This study provides objective data via histological analysis in support of a nickel allergic sensitization in failed arthroplasties where clinical and/or radiographic abnormalities may not be apparent. Biopsy for CD4+/CD8+ cell counts may provide further proof of the existence of nickel sensitization in lymphocyte stimulation test positive patients, and more importantly, may implore the surgeon to consider low nickel implant design in these patients.

Twitter Demographics

The data shown below were collected from the profile of 1 tweeter who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 15 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
Unknown 15 100%

Demographic breakdown

Readers by professional status Count As %
Student > Master 4 27%
Student > Bachelor 3 20%
Researcher 3 20%
Student > Ph. D. Student 1 7%
Other 1 7%
Other 0 0%
Unknown 3 20%
Readers by discipline Count As %
Medicine and Dentistry 6 40%
Nursing and Health Professions 3 20%
Sports and Recreations 1 7%
Engineering 1 7%
Unknown 4 27%

Attention Score in Context

This research output has an Altmetric Attention Score of 2. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 23 May 2019.
All research outputs
#7,794,825
of 13,877,211 outputs
Outputs from Journal of Experimental Orthopaedics
#32
of 85 outputs
Outputs of similar age
#133,483
of 271,179 outputs
Outputs of similar age from Journal of Experimental Orthopaedics
#1
of 1 outputs
Altmetric has tracked 13,877,211 research outputs across all sources so far. This one is in the 42nd percentile – i.e., 42% of other outputs scored the same or lower than it.
So far Altmetric has tracked 85 research outputs from this source. They receive a mean Attention Score of 4.2. This one has gotten more attention than average, scoring higher than 61% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 271,179 tracked outputs that were published within six weeks on either side of this one in any source. This one is in the 48th percentile – i.e., 48% of its contemporaries scored the same or lower than it.
We're also able to compare this research output to 1 others from the same source and published within six weeks on either side of this one. This one has scored higher than all of them