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Indicates sessions with recordings available for purchase.Does metal allergy play a role in long-term outcomes for patients with TMJ TJR?
With increased need and the advent of safer materials, TMJ total joint replacements (TJRs) have become more prevalent over the past several decades. Despite their biocompatibility with most patients, some of the metals that provide strength to the TJRs are also considered common allergens including nickel, chromium and cobalt. It is accepted that there are a percentage of patients that do not respond well after TJR and return postoperatively with confounding symptoms of an unknown etiology. These symptoms often include recurrent swelling in the absence of infection or refractory neuropathic-like pain. It is thought that these symptoms, along with some others, could be caused by an allergic reaction to the metal components in the joint. We propose that all patients should, therefore, undergo metal allergy testing prior to any total joint replacement to ensure a higher level of post-operative success.
Purpose:The aim of the study was to compare outcomes of total joint prosthesis patients who did and did not receive allergy testing prior to surgery.
Patients and Methods: A retrospective analysis of 18 patients receiving 29 total joint prostheses from a single surgeon (J.P.M.) between January 2011 to December 2015 was performed. Preoperative allergy testing was implemented on 9 patients with 15 joints, which included either a patch test by an immunologist or in vitro testing using the lymphocyte transformation test. If an allergy was discovered, an alternative prosthesis that did not include the allergen was selected . The control group, which consisted of 9 patients with 14 total joints, did not receive any preoperative allergy testing. However, allergy testing was implemented postoperatively if clinical symptoms were suspicious for metal allergy.
Evaluations were performed at the initial preoperative visit, 1 month postoperative and 1 year postoperative. These consisted of a visual analog scale of each joint (0 = worst 100 = no pain), perceived jaw function (0=no function 100 = normal function), maximal interincisal opening and diet (soft, compromised or regular). Statistical analysis was performed with a t-test to determine statistical significance.
Results: Average compared VAS scores were not statistically significant different at 1 month but did show a significant improvement at 1 year in the allergy tested group. (mean=66.42 vs 86.66; p=0.027) Average compared jaw function scores showed no statistically significance at 1 month but were significantly improved at 1 year in the allergy tested group. (mean 68.5 vs 84.66; p=0.04). There was no statistically significant difference in maximal interincisial opening or diet at 1 month or 1 year postoperatively. Of relevance, 4 patients in the control group were tested for allergies due to suspicious clinical signs (eg recurrent swelling in the absence of infection, refractory neuropathic-like pain). 3 out of the 4 patients showed an allergic reaction to one of the components in the prosthesis. 1 of the 4 patients subsequently underwent an explant. 0 of the 9 allergy tested patients required a revision or explant.
Conclusion: Testing individuals for allergies may help improve long-term patient outcomes in regards to pain and jaw function.
References:
Sidebottom A J, and Mistry K: Prospective analysis of the incidence of metal allergy in patients listed for total replacement of the temporomandibular joint. British Journal of Oral and Maxillofacial Surgery 52.1: 85-86, 2014
Thyssen, J P et al: Pragmatic approach to the clinical work‐up of patients with putative allergic disease to metallic orthopaedic implants before and after surgery. British Journal of Dermatology 164.3: 473-478, 2011