Metal allergies may affect joint replacement success

One bizarre cause of joint replacement failure… next

Metal allergies may affect joint replacement success

Kathryn Doyle writing for Reuters reported metal sensitivities can lead to failure of replacement joints, and patients should be carefully evaluated for a possible reaction after the surgery, according to a new review of past research.

“We think patients and doctors should be aware of hypersensitivity or allergy reactions to implanted joints and to monitor for signs and symptoms,” said Dr. Michelle L. Pinson, one of the authors of the new paper.

“However, a hypersensitivity reaction to a hip or knee replacement is not that common, when you look at all the patients who have had successful and stable joint replacements,” added Pinson, of Wilford Hall Ambulatory Surgical Center in San Antonio, Texas.

The number of total joint replacements in the U.S. is on the rise, and so is the number of revisions, according to the authors.
Earlier replacement joints were all-metal and prone to shedding as the parts rubbed against each other and surrounding tissue.

Cobalt, chromium, molybdenum, tungsten, manganese, titanium, aluminum, vanadium and nickel are all common metals used in joint replacements.
According to an unrelated 2010 study in Chemical Research in Toxicology, up to 17% of women and 3% of men are allergic to nickel.

“For some patients, an allergic reaction to metal in a joint can be very serious, however many reactions are mild and not too serious,” Pinson said.

There is no consensus on how to treat that kind of joint failure, they note, but for minor cases pain may be managed with medications, physical therapy or steroid injections.
If the joint swells or loosens, it may need to be replaced with different components, for example non-nickel components if that’s what causing the trouble.

Pinson and her colleagues included randomized controlled trials, case studies, observational studies and previous reviews in their analysis, which was published in the Annals of Allergy, Asthma & Immunology.
Among their conclusions is that it’s still not clear whether metal joints increase sensitivity to metal, or if existing metal sensitivity leads to more joint failure after implantation.

Comment: A potentially serious complication related to joint replacement.

Why do people with knee arthritis get worse… one answer lies in the following…

Sara Freeman writing for Medwire News reported patients with early symptomatic osteoarthritis (OA) of the knee avoid performing normal daily physical activities because they are experiencing pain, findings of a large, longitudinal study suggest.
Low vitality was also associated with a greater chance of patients avoiding physical activities, such as walking and stair climbing, in the multicentre CHECK (Cohort Hip & Cohort Knee) study.

“The results support the validity of the avoidance model in persons with early symptomatic knee OA,” said study author Jasmijn Holla, from the Amsterdam Rehabilitation Research Center in Reade, the Netherlands.

This model assumes that pain and psychological distress lead to the avoidance of activities and that this, in turn, can lead to muscle weakness and subsequent activity limitation.

Comment: This is a vicious cycle which all too unfortunately ends up in joint replacement.

Does PRP Work? Everyone has their own opinion….

Platelet-Rich Plasma Injections May Not Help Hamstring Muscles Heal Faster
Gene Emery writing for Reuters reported that according to a report published in the New England Journal of Medicine, platelet-rich plasma injections into hamstring muscles that are acutely injured do not help the muscles heal any faster than placebo injections. The study involved 80 athletes. “For our clinic, in our practice, we don’t use this treatment for muscle injuries anymore because the evidence shows there’s no benefit,” chief author Dr. Gustaaf Reurink of the Erasmus Medical Center in Rotterdam, the Netherlands, told Reuters Health. But the study results, reported in a letter in the New England Journal of Medicine, may not be widely embraced.

“I’d hate for people to throw the baby out with the bathwater here,” said Dr. Michael Terry, an orthopedic surgeon at Northwestern University Feinberg School of Medicine in Chicago. He asserted that the technique “works for recurrent or chronic muscle injuries. I think it’s one of the areas where it can be very useful. There are other data that suggest it’s helpful.”

Comment: Our experience is that it does work. However, I agree that large double blind studies are needed.

If you have ankylosing spondylitis, this next item is for you…

Physically Demanding Jobs May Be Associated With Greater Ankylosing Spondylitis Progression.

Mitchel Zoler writing for Rheumatology News reported that research indicated that individuals “with ankylosing spondylitis who worked at more physically-demanding jobs showed greater radiographic progression than did patients who performed more sedentary jobs.” When the researchers “analyzed job activity in subgroups divided by sex, they found that the relationship between a more physically demanding job and increased radiographic progression remained statistically significant in men, but the relationship was no longer significant in women.”


Comment: A very interesting finding and one that is important to know for patients with the disease.


More good news about the use of stem cells for osteoarthritis… next

Stem cell mobilization therapy may effectively treat osteoarthritis

Researchers in Taiwan have found that peripheral blood stem cells can be “mobilized” by injection of a special preparation of granulocyte colony-stimulating factor (G-CSF) into rats that modeled osteoarthritis (OA). The bone marrow was stimulated to produce stem cells, leading to the inhibition of OA progression. The finding, they said, may lead to a more effective therapy for OA, a common joint disease that affects 10 percent of Americans over the age of 60.

The study will be published in a future issue of Cell Transplantation.

Comment: This is an odd but intriguing technique that might just work.

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