1.
Allergic or Hypersensitivity Reactions to Orthopaedic Implants.
Roberts, TT, Haines, CM, Uhl, RL
The Journal of the American Academy of Orthopaedic Surgeons. 2017;(10):693-702
Abstract
Allergic or hypersensitivity reactions to orthopaedic implants can pose diagnostic and therapeutic challenges. Although 10% to 15% of the population exhibits cutaneous sensitivity to metals, deep-tissue reactions to metal implants are comparatively rare. Nevertheless, the link between cutaneous sensitivity and clinically relevant deep-tissue reactions is unclear. Most reactions to orthopaedic devices are type IV, or delayed-type hypersensitivity reactions. The most commonly implicated allergens are nickel, cobalt, and chromium; however, reactions to nonmetal compounds, such as polymethyl methacrylate, antibiotic spacers, and suture materials, have also been reported. Symptoms of hypersensitivity to implants are nonspecific and include pain, swelling, stiffness, and localized skin reactions. Following arthroplasty, internal fixation, or implantation of similarly allergenic devices, the persistence or early reappearance of inflammatory symptoms should raise suspicions for hypersensitivity. However, hypersensitivity is a diagnosis of exclusion. Infection, as well as aseptic loosening, particulate synovitis, instability, and other causes of failure must first be eliminated.
2.
Device use: walking AIDS, braces, and orthoses for symptomatic knee osteoarthritis.
Gross, KD
Clinics in geriatric medicine. 2010;(3):479-502
Abstract
With too few conservative options in the current medical system, increasing numbers of osteoarthritis (OA) sufferers are using untested folk remedies and self-prescribed dietary supplements. There is enormous popular demand for noninvasive and nonpharmacologic therapies for OA, and there is a pressing need for clinicians to respond to this demand by updating their practice. This review introduces clinicians to the most important noninvasive devices used in the conservative management of knee OA. Because the shared goal of these devices is to favorably alter lower limb biomechanics, each section of the review considers evidence of biomechanical and clinical efficacy.