Metal Sensitization After Arthroplasty More Likely for Women

HealthDay News — Among patients reporting pain but no infection after total joint arthroplasty (TJA), women have a higher rate and greater severity of metal sensitization than men, according to a study published April 19 in the Journal of Bone & Joint Surgery.

Marco S. Caicedo, PhD, from Rush University Medical Center in Chicago, and colleagues retrospectively analyzed sex-associated rates and levels of metal sensitization in 1038 male and 1575 female subjects with idiopathic joint pain after TJA who were referred for in vitro metal-sensitivity testing.

The researchers found that females demonstrated a significantly higher rate and greater severity of metal sensitization than males. The median lymphocyte stimulation index (SI) was significantly lower among males than among females. SI of ≥4 (reactive) was more common in females than males (49% vs 38%). Implant-related pain was also significantly higher in females than males.

“In a select group of patients who had joint pain following TJA and no evidence of infection and who were referred for metal-sensitivity testing, females exhibited a higher level of pain and demonstrated a higher rate and severity (as measured by lymphocyte SI) of metal sensitization compared with males,” concluded the authors.

Several authors are employees of Orthopedic Analysis, which provided funding for the study, and one author disclosed ties to Bioengineering Solutions.

References

Caicedo MS, Solver E, Coleman L, Jacobs J, Nadim JH. Females with unexplained joint pain following total joint arthroplasty exhibit a higher rate and severity of hypersensitivity to implant metals compared with males: implications of sex-based bioreactivity differences. J Bone Joint Surg. 2017;88(8):621-628. doi:10.2106/JBJS.16.00720

Schwarz EM. Confirmation of sexual dimorphisms in metal hypersensitivity and joint pain following total joint arthroplasty: commentary on an article by Marco S. Caicedo, PhD, et al.: Females with unexplained joint pain following total joint arthroplasty exhibit a higher rate and severity of hypersensitivity to implant metals compared with males: implications of sex-based bioreactivity differences. J Bone Joint Surg. J Bone Joint Surg. 2017;99(8):e41. doi:10.2106/JBJS.16.01496