When we are confronted with a joint replacement recommendation by our doctor it is so important to get informed and know what to expect. We are often concerned about the pain, the recovery time, and the cost. But have you ever thought about having an allergy to the materials used in the replacement implant? Allergy to the implant materials is an actual issue, and a new concern for individual with joint pain facing joint replacement. It’s also another good reason to investigate other options when confronted with a surgical referral. In several previous articles, we have discussed how Regenerative Orthopedics is as an effective alternative to surgery, and one that really should be strongly considered. Why not just have surgery? Of course, there are times when surgery is necessary. However, every time a surgeon cuts, shaves and/or removes parts of a joint, there is always an increased possibility for the development of arthritis, degeneration and further pain in that joint. That’s because the removal of tissue causes the joint to become more unstable, since these soft tissue structures are what provide much of the stability in the joint.  Besides, why go through the pain and expense of surgery when you don’t need to? Now there is another reason to look for an alternative to surgery…scientists are documenting the risk of allergy from implants.<a href="#_edn1" name="_ednref1">[i]</a>

What is being said about allergy from metal implants? “Metal allergy is in fact a well-documented factor in the failure of implants, and the need for allergy testing in sensitive patients is well recognized by both implant manufacturers and by surgeons alike.” And in this study, “All of the samples studied contained a consistent yet low percentage of components to which allergies have been contributed.”<a href="#_edn2" name="_ednref2">[ii]</a> But even small amounts are sufficient to cause an allergic reaction.

What are the symptoms of metal allergy? “Patients suffering from metal hypersensitivity may have numerous local symptoms associated with an overactive immune system, such as localized pain, swelling, cutaneous allergic reactions, joint and muscle pain, implant failure, apparent recurrent infections around the operation site, and possible systemic reactions such as fibromyalgia, chronic fatigue and cognitive impairment.”<sup>ii </sup>As you can, some of these hypersensitivity reactions are chronic auto-immune type illnesses. A far cry from what the individual thought they were signing up for when choosing the surgical implant…freedom from pain and suffering.

Titanium used to be thought of as one of the safer metals, and in fact was used as the implant of choice for patients suffering from allergies to nickel, chrome, and cobalt. However, the titanium implants also contain these previously noted metals that are causing allergic responses.<sup>ii</sup>

Metals usually found in common medical grade alloys include cobalt, nickel, chrome, stainless steel, and titanium. Many also contain various detectable impurities like aluminum, iron, vanadium, and more.<sup>ii</sup>

It is of utmost importance if you have an allergy to these metals, that you are thoroughly informed about the potential reaction that might result from the choice of implant materials.<a href="#_edn3" name="_ednref3">[iii]</a>
<h2>Corrosion of Implant Materials</h2>
<strong>Allergic response is not the only problem that can occur with implant materials. There is also an issue of corrosion of the implants with wear and tear</strong>.

No matter what materials are used in joint replacements, wear of the implant is a predictable problem.  In fact, wear is the major reason orthopedic implants malfunction. That malfunction actually hastens the problem of corrosion. When implant materials are chosen, they are chosen because of their higher resistance to wear, like metal alloy and ceramics. In hip implants, titanium and its alloys are often used for fabricating the femoral component, and the ball is prepared by either cobalt-chromium alloy or other hard ceramics. The debris that is released with the wear that damages the implant can begin a biological process that activates a brutal inflammatory reaction. The corrosion that transpires from the friction that results from this wear is actually a huge worry because it discharges non-compatible metallic ions that are dispersed into the body. <a href="#_edn4" name="_ednref4">[iv]</a>

Research articles demonstrate plenty of evidence about the issue of corrosion of implants and how the debris results in disease. One article discusses how cobalt alloy debris has been implicated in the early failure of some designs of current total joint implants, and also how the debris from cobalt implants causes an extreme inflammatory reaction and even bone loss.<a href="#_edn5" name="_ednref5">[v]</a>

Here is an excerpt from another article: “Immune reactions to orthopedic implant debris are the primary cause of total joint replacement (TJR) failure over the long term (15–20 years). It has been well established that implant debris causes local inflammation, limiting the long-term performance of the over one million total joint replacements (TJR) implanted each year in the US. Implant debris induces a subtle inflammatory cascade resulting in a slow progression of bone loss… that over time leads to implant failure.”<a href="#_edn6" name="_ednref6">[vi]</a>

The researchers are saying that the debris from implants is definitely a problem and that it causes disease. Obviously, this is not a good scenario.

So, where does the debris go? In research looking at the dissemination of wear particles, the scientists find the debris in the lymph nodes, liver and spleen. “Metallic wear particles in the liver or spleen were more prevalent in patients who had had a failed hip arthroplasty (seven of eight) than in patients who had had a primary hip (two of eleven) or knee replacement (two of ten). Metallic wear particles were detected in the lymph nodes in 68 percent (nineteen) of the twenty-eight patients with an implant from whom lymph nodes were available for study. In this study, systemic distribution of metallic and polyethylene wear particles was a common finding, both in patients with a previously failed implant and in those with a primary total joint prosthesis. The prevalence of particles in the liver or spleen was greater after reconstructions with mechanical failure.”<a href="#_edn7" name="_ednref7">[vii]</a>

Many people contact our office because they are experiencing joint pain and are looking for an alternative to a surgical joint replacement. We offer very effective non-surgical options with Regenerative Orthopedics, including Stem Cell Therapy. At OrthoRegen<sup>®</sup>, we only use the Gold Standard in Stem Cell Therapy, and the procedure only has to be done once. Plus, this non-surgical therapy not only provides a non-surgical option, but also helps you to avoid an allergic response from the implants used in joint replacement or the pathology that can occur from the debris caused by corrosion.

We strongly recommend looking into non-surgical Regenerative Orthopedics with Peter A. Fields, MD, DC and OrthoRegen<sup>®</sup> for repair of painful joints before opting for a joint replacement.

Remember, once surgery has been done, it cannot be un-done.

<a href="#_ednref1" name="_edn1">[i]</a> Laitinen, Minna, et al. "High blood metal ion levels in 19 of 22 patients with metal-on-metal hinge knee replacements: A cause for concern." <em>Acta orthopaedica</em> 88.3 (2017): 269-274.

<a href="#_ednref2" name="_edn2">[ii]</a> Harloff, Thomas, et al. "Titanium allergy or not?." <em>Health</em> 2.04 (2010): 306.

<a href="#_ednref3" name="_edn3">[iii]</a> Guenther D, Thomas P, Kendoff D, Omar M, Gehrke T, Haasper C. Allergic reactions in arthroplasty: myth or serious problem? Int Orthop. 2016 Feb;40(2):239-44. doi: 10.1007/s00264-015-3001-6. Epub 2015 Nov 2.

<a href="#_ednref4" name="_edn4">[iv]</a> Gao, Chengde, et al. "Highly biodegradable and bioactive Fe-Pd-bredigite biocomposites prepared by selective laser melting." <em>Journal of advanced research</em> 20 (2019): 91-104.

<a href="#_ednref5" name="_edn5">[v]</a> Samelko, Lauryn, et al. "Cobalt alloy implant debris induces inflammation and bone loss primarily through danger signaling, not TLR4 activation: implications for DAMP-ening implant related inflammation." <em>PLoS One</em> 11.7 (2016).

<a href="#_ednref6" name="_edn6">[vi]</a> Samelko, Lauryn, et al. "TLR4 (not TLR2) dominate cognate TLR activity associated with CoCrMo implant particles." <em>Journal of Orthopaedic Research</em> 35.5 (2017): 1007-1017.

<a href="#_ednref7" name="_edn7">[vii]</a> Urban, Robert M., et al. "Dissemination of wear particles to the liver, spleen, and abdominal lymph nodes of patients with hip or knee replacement." <em>JBJS</em> 82.4 (2000): 457.

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