Do Patients With Hypoallergenic Total Knee Arthroplasty Implants for Metal Allergy Do Worse? An Analysis of Health Care Utilizations and Patient-Reported Outcome Measures

Joshua L Tidd; Lakshmi Spandana Gudapati; Hannah L Simmons; Alison K Klika; Ignacio Pasqualini; Cleveland Clinic Arthroplasty Group; Nicolas S Piuzzi

doi:10.1016/j.arth.2023.07.005

Do Patients With Hypoallergenic Total Knee Arthroplasty Implants for Metal Allergy Do Worse? An Analysis of Health Care Utilizations and Patient-Reported Outcome Measures

J Arthroplasty. 2024 Jan;39(1):103-110. doi: 10.1016/j.arth.2023.07.005. Epub 2023 Jul 15.

Authors

Joshua L Tidd¹, Lakshmi Spandana Gudapati², Hannah L Simmons², Alison K Klika², Ignacio Pasqualini²; Cleveland Clinic Arthroplasty Group²; Nicolas S Piuzzi³

Collaborators

Cleveland Clinic Arthroplasty Group:
Carlos A Higuera, Robert M Molloy, Trevor G Murray, Michael R Bloomfield, Jonathon L Schaffer, John P McLaughlin, Matthew E Deren, Peter A Surace, Viktor E Krebs

Affiliations

¹ Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio; College of Medicine, Northeast Ohio Medical University, Rootstown, Ohio.
² Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio.
³ Department of Orthopaedic Surgery, Cleveland Clinic, Cleveland, Ohio; Department of Biomedical Engineering, Cleveland Clinic, Cleveland, Ohio.

PMID: 37454947
DOI: 10.1016/j.arth.2023.07.005

Abstract

Background: Metal allergy is a rare and controversial cause of implant failure and poor outcomes following total knee arthroplasty (TKA). Few studies have investigated clinical and patient-reported outcome measures (PROMs) in patients treated with hypoallergenic implants. This investigation aimed to compare: (1) health care utilizations (eg, hospital length of stay, 90-day readmission rate, and incidence of nonhome discharge) and (2) 1-year PROMs between patients who received hypoallergenic and standard TKA implants.

Methods: This was a retrospective review of prospectively collected data from patients who underwent primary TKA between 2018 and 2019. Propensity score matching (3:1) was used to compare standard TKA patients with those who received hypoallergenic TKA implants, respectively. Knee injury and Osteoarthritis Outcome Score (KOOS) pain, KOOS Physical function Shortform (PS), and Veterans RAND 12-Item Health Survey Mental Component Score were collected preoperatively and at 1-year. After matching, 190 hypoallergenic and 570 standard TKAs were analyzed.

Results: No differences were observed in length of stay (P = .98), 90-day readmission (P = .89), and nonhome discharge (P = .82). Additionally, there was no significant difference in change from preoperative to 1-year PROMs (KOOS pain, P = .97; KOOS PS, P = .88; Veterans RAND 12-Item Health Survey Mental Component Score, P = .28). Patient-reported satisfaction was similar at 1-year (P = .23). Patients achieved similar rates of Patient Acceptable Symptom State (PASS) and minimal clinically important difference (MCID) for KOOS pain (PASS, P = .77; MCID, P = .33) and KOOS PS (PASS, P = .44; MCID, P = .65).

Conclusion: Patients treated with hypoallergenic TKA implants for suspected metal allergy had similar outcomes compared to patients who had standard implants and no metal allergy.

Keywords: health care utilization; metal allergy; metal hypersensitivity; nickel allergy; satisfaction; total knee arthroplasty.

MeSH terms

Arthroplasty, Replacement, Knee* / adverse effects
Health Surveys
Humans
Hypersensitivity* / epidemiology
Hypersensitivity* / etiology
Hypersensitivity* / surgery
Osteoarthritis, Knee* / surgery
Pain / surgery
Patient Acceptance of Health Care
Patient Reported Outcome Measures
Patient Satisfaction
Treatment Outcome