Allergy Testing Has No Correlation with Intraoperative Histopathology from Revision Total Knee Arthroplasty for Implant-Related Metal Allergy

J Knee Surg DOI: 10.1055/s-0041-1729618Lymphocyte transformation testing (LTT) is often used in the workup for possible metal allergy after total knee arthroplasty (TKA) but the correlation of this test with other diagnostic metal-allergy findings in patients undergoing revision TKA for suspected metal allergy has not been established. A single-center, single-surgeon cohort of 19 TKAs in which both components were revised for presumed implant-related metal allergy based on history, physical, and LTT testing, to nonnickel-containing implants were retrospectively identified. Histopathologic samples obtained intraoperatively were semiquantitatively analyzed using both the Hospital for Special Surgery (HSS) synovial pathology score and the Campbell aseptic lymphocyte-dominant vasculitis-associated lesion (ALVAL) score. As histopathology control group, we included in the study an additional cohort of 17 patients who received aseptic revision TKA and had no history of reported or tested metal sensitivity. All preoperative LTT results were highly reactive to nickel. However, this did not correlate with local periarticular tissue response in 18 of 19 cases which demonstrated a low HSS synovial score (mean: 3.8 ± 2.8, of a maximum score of 28) and the low Campbell ALVAL scores (mean: 2.5/10 ± 1.3, of a maximum score of 10). There were not any significant differences between the study group (suspected implant-related metal allergy) and the cont...
Source: Journal of Knee Surgery - Category: Orthopaedics Authors: Tags: Original Article Source Type: research

Related Links:

Urticarial vasculitis is a small vessel vasculitis characterized by urticarial lesions which can leave bruising upon resolution. It often causes pain and pruritus and can be difficult to treat with traditional medications thereby adversely affecting quality of life.
Source: Annals of Allergy, Asthma and Immunology - Category: Allergy & Immunology Authors: Source Type: research
Patient Presentation A 9-year-old male came to clinic with a 1 month history of painful joint swelling. One month ago he started having right ankle pain that was intermittent but consistent. One day ago his right wrist, right ankle and bilateral knees had some swelling but no erythema or warmth. He says that he has pain in them when he moves but not when he is resting and he denies any joint stiffness or gelling. He also had 1-2 days of multiple red skin lesions on his extremities and trunk, not overlying the affected joints. The skin lesions do not come and go and do not itch. They are mainly discrete circular lesions wi...
Source: PediatricEducation.org - Category: Pediatrics Authors: Tags: Uncategorized Source Type: news
Rheumatology key messageIgG4-related disease might be an alternative diagnosis in limited granulomatosis with polyangiitis. Sir, IgG4-related disease (IgG4-RD) is a fibro-inflammatory disease that can affect almost every organ [1]. Indeed, previous unexplained conditions have now been reclassified as primarily IgG4-RD and may imitate many inflammatory, infectious and malignant disorders often leading to a delay in diagnosis or incorrect diagnosis. Nasal manifestation of IgG4-RD, mostly of the paranasal sinuses, has previously been described in case reports, but it can also manifest as a primary or secondary nasal disease s...
Source: Rheumatology - Category: Rheumatology Source Type: research
​BY AARON SNYDER, MDInfectious processes, such as streptococcal infections, can partially masquerade as alternative diagnosis. Streptococcal infections are a frequent source of infection treated by emergency physicians, and it is crucial that the appropriate tests, antibiotics, and hospitalization are used to recognize rash patterns and to identify causes and the differential of causation.A 60-year-old woman presented from her primary medical doctor's office with fever, fatigue, tachycardia, and facial discomfort for two days that developed into a malar rash. The patient reported one day of fever, several days of sore th...
Source: The Case Files - Category: Emergency Medicine Tags: Blog Posts Source Type: research
Discussion α-1-Antitrypsin Deficiency (A1AT) is a common single-gene mutation disease that is homozygous recessive. The normal allele is called M and the most common abnormal allele is Z. There are other alleles though. The gene codes for one of the primary protease inhibitors in the serum, thus those who are homozygous for the Z gene are sometimes referred to as “PIZZ” or “PIZ.” α-1-Antitrypsin is found in all body tissues but is especially important in the serum and lung. As noted it is one of the primary neutrophil protease inhibitors in the serum, and acts to neutralize these enzymes...
Source: PediatricEducation.org - Category: Pediatrics Authors: Tags: Uncategorized Source Type: news
A 29 year old male presented with headache and no neurological signs. MRI brain strongly suggested an aggressive primary brain tumour in the right frontal lobe but histopathology revealed a pleomorphic lymphoid infiltrate, necrosis and vague granulomata and vasculitis was diagnosed. There was aggressive clinico-radiological progression despite two debunking surgeries, corticosteroids and cyclophosphamide. On review the following were noted: areas of necrosis and focal diffuse lymphoid infiltrate showing perivascular cuffing; the presence of granuloma formation and vascular necrosis was less certain; overwhelming predominan...
Source: Journal of Neurology, Neurosurgery and Psychiatry - Category: Neurosurgery Authors: Tags: Genetics, Immunology (including allergy), Headache (including migraine), Pain (neurology), Drugs: musculoskeletal and joint diseases, Vascularitis, Surgical oncology ABN Annual Meeting, 17-19 May 2016, The Brighton Centre, Brighton Source Type: research
Authors: Hartmann D, Letulé V, Schneider JJ, Flaig MJ Abstract Metal implant sensitivity (intolerance) can cause pain, reduced mobility, loosening of the implant and skin rashes. Knowledge of differential diagnoses, histology and appropriate diagnostics are essential for proper diagnosis. To outline typical clinical signs and histology in metal-implant-associated skin lesions we present three exemplary patients from our implant allergy outpatient department and give an overview of the current literature regarding metal implant sensitivity. In patients with a negative patch test the lymphocyte transformation ...
Source: Der Hautarzt: Zeitschrift fur Dermatologie, Venerologie, und verwandte Gebiete - Category: Dermatology Tags: Hautarzt Source Type: research
Leukocytoclastic vasculitis (LCV), also called cutaneous small-vessel vasculitis, is a disorder characterized by neutrophilic inflammation predominantly limited to the superficial cutaneous postcapillary venules.1 It usually presents as a palpable nonblanching purpuric rash that may be associated with pruritus, pain, and burning, without any apparent systemic or extracutaneous involvement.2,3 The cutaneous manifestations appear at the lower legs and buttocks but sometimes may present at the trunks and upper extremity.
Source: Annals of Allergy, Asthma and Immunology - Category: Allergy & Immunology Authors: Tags: Letter Source Type: research
Discussion HSP is a rather common disease in children with systemic hypersensitivity vasculitis in the skin and other organs including the kidneys. It rarely involves the myocardium or pericardium and is even rarer to present as a large pericardial effusion, especially in an adult. HSP presenting as pericardial disease has only been reported in a few cases. Although the pericardial involvement of Henoch-Schonlein Purpura seen in this patient is rare, any collagen vascular disease can present with pericardial effusion and might respond to appropriate anti-inflammatory therapies including steroids if recognized promptly.
Source: Journal of Investigative Medicine - Category: Research Authors: Tags: Rheumatology/Immunology/Allergy Source Type: research
Conclusion Although HSP patients mostly range from 4–7 years old it can still presents in adolescent age group. Non-thrombocytopenic palpable purpura with multi-organ involvement (gastrointestinal, skin and joints) should make one consider the diagnosis. skin biopsy should be taken less than 24 hrs from the presentation because in more chronic lesions, vessel damage leads to nonspecific leakage of all isotypes of immunoglobulin. Abstract ID: 67 Figure 1
Source: Journal of Investigative Medicine - Category: Research Authors: Tags: Rheumatology/Immunology/Allergy Source Type: research
More News: Allergy | Allergy & Immunology | Hospitals | Orthopaedics | Pain | Pathology | Study | Vasculitis