[Allergic dermatitis caused by metallic implants in orthopedic surgery].

PURPOSE OF THE STUDY: Dermatitis due to metallic implants in orthopaedic surgery are uncommon complications and are difficult to diagnose.

MATERIAL AND

METHODS

A literature review found descriptions of 54 cases. All types of implants, even small in size such as screws or loops, made of stainless steel or chromium-cobalt alloys have been incriminated. There was no case related to titanium alloy.

RESULTS

The clinical aspects were very different; all the forms of dermatitis are possible. The most frequent were eczemas (44 per cent), bullous dermatitis (11 per cent) and inflammatory forms (13 per cent).

DISCUSSION: These dermatitis result either from immuno-allergic mechanisms or from cell-toxicity. There are two main diagnostic difficulties. 1--To confirm the responsibility of the implant in the dermatitis because the cutaneous lesions appears often generalized or localized in an area distant from the implant and because their emergence may be very belated, sometime after several years. 2--To distinguish some of these dermatitis and especially inflammatory forms, from sepsis. There is no current means to state positively this diagnosis without removing the implant. The microscopic tissues analysis surrounding the implant and the cutaneous patch-tests using fillings of the implant itself are the only methods which appear able to confirm the diagnosis. There are no reliable means to detect risk subjects, the emergence of a dermatitis seems to be unpredictable. The specificity and the sensibility of the usual patch-tests are insufficient.

CONCLUSION

The main means to prevent dermatitis is to reduce the production of metallic particles due to wear, fritting and corrosion. Management is based on removing of the incriminated implant. Treatment using drugs, including local applications or general dispensing of steroids, have generally a low efficiency.