PDF(Pubmed)
Abstract：
BACKGROUND: The frequency of primary joint replacement surgery continues to increase worldwide. While largely considered biologically inert entities, an increasing body of evidence continues to validate a not insignificant incidence of allergic reactions to such implants. Little previous work has explored genuinely immune-mediated reactivity in this context. In the absence of a contemporary published summary on the topic, this paper explored the current state of understanding of cobalt/chromium allergy and proposes a patient management algorithm whereby such immune reactions are clinically suggested.
METHODS: A structured, systematic literature review was performed by following PRISMA search principles to provide an updated review of this area.
RESULTS: Thirty-six topic-related articles were identified, the majority reflecting lower tiers of scientific evidence with a lack of homogeneous quantitative data to facilitate valid cohort comparisons. Largely, the available literature represented small case series\' or expert opinions.
CONCLUSIONS: Despite increasing clinical awareness and acknowledgement of true allergy to joint replacement components, this review highlighted that the evidence base underpinning the diagnosis and management of such patients is limited. Both patient-reported metal allergy or skin patch testing are grossly unreliable methods and show almost no correlation with true immune reactivity. Recent studies suggested a potential role for patient-specific in vitro cellular activation testing and/or targeted genetic testing when cobalt/chromium allergy is clinically suspected. However, while likely representing the contemporary \"best available\" approaches both can be costly undertakings, are not yet universally available, and still require broader validation in non-research settings before wider uptake can be championed.
METHODS: A structured, systematic literature review was performed by following PRISMA search principles to provide an updated review of this area.
RESULTS: Thirty-six topic-related articles were identified, the majority reflecting lower tiers of scientific evidence with a lack of homogeneous quantitative data to facilitate valid cohort comparisons. Largely, the available literature represented small case series\' or expert opinions.
CONCLUSIONS: Despite increasing clinical awareness and acknowledgement of true allergy to joint replacement components, this review highlighted that the evidence base underpinning the diagnosis and management of such patients is limited. Both patient-reported metal allergy or skin patch testing are grossly unreliable methods and show almost no correlation with true immune reactivity. Recent studies suggested a potential role for patient-specific in vitro cellular activation testing and/or targeted genetic testing when cobalt/chromium allergy is clinically suspected. However, while likely representing the contemporary \"best available\" approaches both can be costly undertakings, are not yet universally available, and still require broader validation in non-research settings before wider uptake can be championed.
摘要：
背景：在全球范围内，初次关节置换手术的频率持续增加。虽然在很大程度上被认为是生物惰性实体，越来越多的证据继续证实对这种植入物的过敏反应的发生率并不明显。在这种情况下，以前的工作很少探索真正的免疫介导的反应性。在没有关于该主题的当代出版摘要的情况下，本文探讨了钴/铬过敏的理解现状，并提出了一种患者管理算法，从而在临床上建议这种免疫反应。
方法：结构化，通过遵循PRISMA搜索原则进行系统文献综述,以提供该领域的最新综述.
结果：确定了36篇与主题相关的文章，大多数反映了较低级别的科学证据，但缺乏同质的定量数据来促进有效的队列比较。很大程度上,可用的文献代表小案例系列或专家意见。
结论：尽管临床对关节置换组件的真正过敏认识和认识不断提高，这篇综述强调,支持此类患者诊断和治疗的证据基础有限.患者报告的金属过敏或皮肤贴片测试都是非常不可靠的方法，并且几乎与真正的免疫反应性没有相关性。最近的研究表明，当临床怀疑钴/铬过敏时，患者特异性体外细胞活化测试和/或靶向遗传测试具有潜在作用。然而,虽然很可能代表当代“最佳可用”方法，但这两种方法都可能是昂贵的事业，还没有普及，并且在支持更广泛的吸收之前，仍然需要在非研究环境中进行更广泛的验证。
方法：结构化，通过遵循PRISMA搜索原则进行系统文献综述,以提供该领域的最新综述.
结果：确定了36篇与主题相关的文章，大多数反映了较低级别的科学证据，但缺乏同质的定量数据来促进有效的队列比较。很大程度上,可用的文献代表小案例系列或专家意见。
结论：尽管临床对关节置换组件的真正过敏认识和认识不断提高，这篇综述强调,支持此类患者诊断和治疗的证据基础有限.患者报告的金属过敏或皮肤贴片测试都是非常不可靠的方法，并且几乎与真正的免疫反应性没有相关性。最近的研究表明，当临床怀疑钴/铬过敏时，患者特异性体外细胞活化测试和/或靶向遗传测试具有潜在作用。然而,虽然很可能代表当代“最佳可用”方法，但这两种方法都可能是昂贵的事业，还没有普及，并且在支持更广泛的吸收之前，仍然需要在非研究环境中进行更广泛的验证。
