Knee prosthesis: sudden allergies possible?

Can allergies to metal or cement suddenly occur?

Yes, everyone notices changes in themselves over time. For example, you can no longer tolerate certain foods, which used to be no problem. And so the immune system also changes, which is further influenced by external factors.

An allergy is based on a functional but misdirected defence that is directed against the body's own or harmless structures, such as components of an artificial knee joint that contain cement or metal ions.

This misdirection of the immune system causes chronic inflammation on the contact surfaces of the body. This manifests itself as a burning pain from the inside, chronic joint effusion, itchy skin rashes and even loosening of the artificial knee joint. A metal or cement allergy does not necessarily occur immediately after the procedure. It can develop slowly, usually within the first four years after the operation.

Causes of sudden allergies

There are several reasons why an allergy can only occur in old age. Vitamin D, zinc and iron play an important role in the immune response. These are often reduced in older people because their diet is too unbalanced or too poor. In addition, the intestine absorbs substances less well than it used to. Proton pump inhibitors, which reduce stomach acid, can also promote an allergy. Due to the low production of stomach acid, proteins are incompletely digested in the stomach and are no longer excreted, but enter the bloodstream via the intestine. These incompletely digested proteins activate the immune system against otherwise harmless food components. In addition, the stomach produces less acid in older people, which further promotes what has been described above. Not only does the protective function inside the body decline with age, the skin also becomes more permeable to harmful substances. The water content of the skin decreases and it becomes dry and cracked. This makes it easier for harmful substances from ointments, cleaning agents, cosmetics or jewellery metals to penetrate the skin. Nickel jewellery that has been worn on the finger or in the ears for years can suddenly trigger an allergy.

Another risk for newly occurring allergies is our environment with its air pollutants. Fine dust, soot particles and nitrogen dioxide (NO2) combine with harmless pollen. The immune system categorises these altered pollens as dangerous and forms antibodies against them, which leads to the corresponding allergy.

Allergic reactions after joint replacement surgery

There are increasing reports of allergic reactions following joint replacement surgery. An increasing sensitisation to metals such as nickel (approx. 13%), cobalt (approx. 3%) and chromium (approx. 1%) has also been observed in the general population. Women before the age of 40 in particular show a much higher rate of sensitisation to nickel compared to men, probably due to wearing costume jewellery. For this reason, women have a much higher allergisation rate than men with increasing age. It is assumed that in future, more patients who have to be fitted with an implant will have to reckon with an allergic reaction to implant materials.

Special prostheses for allergy sufferers

Normal knee prostheses are made of stainless steel, an alloy consisting of a mixture of cobalt, chromium, molybdenum and nickel. To prevent the development of an allergy to these components over time, we use body-compatible implants, so-called allergy prostheses, wherever possible.

To obtain a smoother surface, the allergy prosthesis is sprayed with titanium. This results in less wear and tear and better gliding of the artificial joint. In addition, the titanium coating prevents possible allergens, such as nickel, from being released from the metal. As a result, there is less irritation of the tissue, less pain and the artificial joint lasts longer. The components of the meniscus replacement (inlay) and the replacement of the back surface of the kneecap are made of plastic (ultra-high molecular weight polyethylene).

Allergy prostheses: LINK® knee surface replacement with gold-coloured PorEx® surface modification (left)
LINK® sled prosthesis with gold-coloured PorEx® surface modification (right)

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Dr Andreas L. Oberholzer is a recognised expert in knee problems and has extensive experience in the field of artificial knee joints and alternative treatment methods.

Book your appointment directly online here or call us on +41 44 388 16 16. You are also welcome to come to us for a second opinion.