 |
Case Report
Vanadium allergy after bilateral total knee arthroplasty: Case report outcome of bilateral revision TKA
1 Harvard Medical School, Boston, MA, USA
2 Massachusetts General Hospital, Boston, MA, USA
Address correspondence to:
Matthew C Johnson
55 Fruit Street, YAW 3700, Boston, MA,
USA
Message to Corresponding Author
Article ID: 100025Z14MJ2021
Access full text article on other devices
Access PDF of article on other devices
How to cite this article
Johnson MC, Robinson MG, Siliski JM. Vanadium allergy after bilateral total knee arthroplasty: Case report outcome of bilateral revision TKA. J Case Rep Images Orthop Rheum 2021;5:100025Z14MJ2021.ABSTRACT
Introduction: Delayed metal hypersensitivity reactions following total knee arthroplasty (TKA) are a poorly understood phenomenon. Their relatively low incidence and insidious presentation make metal allergy a difficult and often-delayed diagnosis. Yet, metal allergies cause significant morbidity and decreased quality of life to the patients who are afflicted by them.
Case Report: We report the case of a 57-year-old woman with progressive erythema, dystonia, and pain after initially uncomplicated bilateral TKA for osteoarthritis. No signs of low-grade infection or mechanical causes of implant failure were present, and extensive workup—including initial 72-hour patch testing—was negative. Ultimately, repeat skin patch testing at 96 hours revealed an allergy to vanadium—a material present in both TKA tibial components. Nonoperative management failed to stop progression of symptoms.
Conclusion: Bilateral revision surgery was performed with cobalt chrome femoral and tibial components free of vanadium, and post-operative evaluations at 1 and 3 months showed outstanding responses. This case illustrates the importance of considering metal allergy screening as part of preoperative care in total joint replacement and provides clinical decision-making guidance on the novel case of vanadium allergy-induced TKA failure.
Keywords: Allergy, Arthroplasty, Revision, Vanadium
SUPPORTING INFORMATION
Author Contributions
Matthew C Johnson - Acquisition of data, Analysis of data, Interpretation of data, Drafting the article, Revising it critically for important intellectual content, Final approval of the version to be published
Matthew G Robinson - Substantial contributions to conception and design, Acquisition of data, Analysis of data, Interpretation of data, Revising it critically for important intellectual content, Final approval of the version to be published
John M Siliski - Substantial contributions to conception and design, Revising it critically for important intellectual content, Final approval of the version to be published
Guarantor of SubmissionThe corresponding author is the guarantor of submission.
Source of SupportNone
Consent StatementWritten informed consent was obtained from the patient for publication of this article.
Data AvailabilityAll relevant data are within the paper and its Supporting Information files.
Conflict of InterestAuthors declare no conflict of interest.
Copyright© 2021 Matthew C Johnson et al. This article is distributed under the terms of Creative Commons Attribution License which permits unrestricted use, distribution and reproduction in any medium provided the original author(s) and original publisher are properly credited. Please see the copyright policy on the journal website for more information.
