Ask the Expert: Metal Allergies

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It’s uncommon, but people can be allergic to the metal in the implant. Dr. Geoffrey Westrich, Orthopedic Surgeon, explains.

Knee replacement is a highly successful surgery in terms of eliminating pain and restoring mobility. It has given countless people a new lease on life. But a limited number of patients who have a metal allergy may develop symptoms following the surgery.

Diane is one such patient. She suffered for almost a year after knee replacement at another hospital. Extremely weak and in terrible pain, the 56 year-old traveled from her home in the Philadelphia area to see me at Hospital for Special Surgery.

She came in after a nine-month ordeal that started after a double knee replacement to get relief from severe arthritis.

Diane chose to have the operation on both knees at the same time. But months later, instead of getting better, her knees still ached. Then the pain started spreading throughout her body to her shoulders, arms and legs. She got weaker and weaker.

Four months after knee replacement, she could no longer get dressed without assistance, pick up a half-gallon of milk or turn over in bed. She says she became a different person — terribly weak, in constant pain and very unhappy.

It turned out she was allergic to the metal in the knee implants, and this was causing severe symptoms throughout her body.

For Diane, it took nine months of searching for answers, of being told you had knee surgery, you’re supposed to be in pain, and of being made to believe she was a nuisance to the doctors she pleaded with for help.

She was finally referred to me and traveled to HSS. When blood tests confirmed Diane was highly allergic to nickel and cobalt, I replaced the implants in both her knees using prostheses that did not contain those metals. The revision surgeries were performed several months apart, and week by week, her pain diminished.

Her symptoms went away after we replaced the metal implants. She is now doing well, has regained the use of her arms, can run errands and walk through a shopping mall.

Although severe reactions to metal implants are rare, orthopedic surgeons are advised to ask patients if they have ever had a reaction to metal, such as costume jewelry. If the answer is yes, the orthopedic surgeon can select an implant that does not contain a specific metal, most commonly cobalt and nickel. If there is any doubt, patients can be tested to see if they may have a metal allergy.

It’s important for any patient who has a problem after joint replacement to see his or her doctor and insist on being taken seriously. If the doctor dismisses the patient’s concerns, the individual should find another physician, preferably at a joint replacement center that does a high number of procedures and is used to dealing with complications. Having the surgery done in such a joint replacement center in the first place gives patients the best chance of a good outcome.

Dr. Geoffrey Westrich, Orthopedic Surgeon, specializes in knee and knee replacement, including revision surgery and complex cases at Hospital for Special Surgery. He is director of research of the Adult Reconstruction and Joint Replacement Service at HSS.

The information provided in this blog by HSS and our affiliated physicians is for general informational and educational purposes, and should not be considered medical advice for any individual problem you may have. This information is not a substitute for the professional judgment of a qualified health care provider who is familiar with the unique facts about your condition and medical history. You should always consult your health care provider prior to starting any new treatment, or terminating or changing any ongoing treatment. Every post on this blog is the opinion of the author and may not reflect the official position of HSS. Please contact us if we can be helpful in answering any questions or to arrange for a visit or consult.


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  1. Hello. I was wondering if you have any doctors that would be closer to Chicago that believe in the metal allergy and knee replacement causing issues. This has been going on for just shy of 3 years. I am only 40 years old now, and I would do anything to get my old life , even with the bad knee, back. I have had 5 surgeries. These past 2 surgeries I have a rash on my legs that just won’t go away and I have had so many treatments for that. I currently just had my last surgery about 7 weeks ago, but the pain is no better, I actually had a bandage put on that had silver in it, and I was home for one day and had to go back to the hospital to remove the bandage. My whole area where the silver was touching my leg had blistered really bad. So now I have a bit more proof that it could be an allergy. My physical therapist says she has no doubt in her mind that is what is going on, especially with all my symptoms. I am at the point where I would rather loose my leg than put up with the pain in there anymore. No doctor around here that I can find seems to believe in having an allergy to the metal. I need help. Do you have any recommendations or doctors that you may know towards Chicago area? I actually live a couple hours outside the city. We need to save up to come out to New York. I saw this article and I thought how wonderful of a doctor you must be to have helped this woman.

  2. I had TKR on my R knee in Feb. 2014. I did my best in PT, but it was terribly painful and I had very limited range of motion. Through this process I discovered that the only pain med which gave me any relief was Fentanyl. I used the patches for 7-10 days, but then developed a tolerance to Fentanyl. I went back for a joint manipulation under anesthesia. The Orthopedist said I had wonderful range of motion during the procedure. Afterwards I again had only limited ROM. He took repeated X-Rays after a year when I was still hurting worse than before the TKR. He was completely satisfied with how the prosthesis looked. I had began having pain and aching in various other joints of my body – neck, wrists, ankles, L knee, SI joint, lower back, hips a few months after the TKR. I was referred to a rheumatologist who ruled out RA, and PMR. An initial two week trial dose of Prednisone was miraculous, but since I have never had an elevated CRP or Sed rate I was taken off the Prednisone. I was referred to a pain management specialist who injected my cervical, lumbar and SI joints with zero improvement. In July of 2015 I had a L arthroscopic meniscectomy with good results. I think I damaged it compensating for the TKR. In August 2015 I had an arthroscopic exploration of my R TKR knee. The scar tissue was found to be almost completely immobilizing my patela and obstructing any view of the knee joint. After the knee specialist cleaned out the scar tissue, I had about a month of quality life before all the pain began to increase again. Even my skin was sensitive to light stroking by this time. Then a second rheumatologist ruled out Fibromyalgia and prescribed Cymbalta and Lyrica with no results so he put the PMR dx back on the table even though my labs had not changed and added 30 mg. of Prednisone on top of the Cymbalta and Lyrica. My pain lessened a little at first on the Prednisone. I had many side effects from the Cymbalta and Lyrica. As per the Dr. orders I am now completely tapered off the Cymbalta, Lyrica, Prednisone and Methotrexate. The withdrawals from Cymbalta and Lyrica were hell. I still have pain in all my joints. My R hip and R knee are the worst. I can hardly walk, can’t put on my shoe and sock, go up and down steps with difficulty, have trouble getting in and out of my car, am not sleeping well at night due to the pain, have zero energy or stamina. I went onto Long Term Disability in March 2015 because my pain was affecting my safety on the job. My current insurance is Cigna. Is there anyone at HSS who can accept my insurance and give me some hope. Life is just not worth living in this condition.`

  3. I had a TKR in February 2013. About 3 months post op I began to have all over joint and muscles aches. After several rounds of prednisone and multiple trips to the ER for things such as shingles, allergic reaction to live poultry(so we think), gallstones, bacterial infection in the bowels, etc etc. I was tested via invitro testing for an allergic reaction to the components of the prosthetic. I remained on prednisone for 10 months. The results were that i was having a toxic reaction to the knee components and cement. In May 2014 I had a revision of the TKR done with what I was told were Non-allergenic materials and that the prosthetic was wrapped with 7 layers of materials to avoid any additional reaction. Initially within the first 8-10 weeks post op I felt really good with no pain except in that joint. Since about week 12-14 post op my all joint pain has become so excruciating that I can barely get dressed without assistance. I have been given prednisone (but was taken off due to liver function test results) methotrexate, lyrica, cymbalta, gabapentin and savella but with no relief. I feel as thought the new knee is just as toxic as the first! Can any of the doctors at HSS take on my case? I am willing to go anywhere for a pain free life!

  4. I had a Total Knee replacement 2 yrs. ago after having 12 other scoops done at this time I can only bend my knee no more then 40 % I’m always in pain and can’t work do to it. there’s a lot going on I go to pain management I’m on pain meds. and would like to get off them . what can I do is there anything that can be done? Please Help

    1. Hi Robert, thank you for reaching out. Dr. Michael Cross, Orthopedic Surgeon, says: After failing multiple scopes, I think the only thing you could consider is a complete revision with aggressive removal of scar tissue. The success after such an operation is highly variable, but there have been patients who had great success in improving their motion. You should consult with your physician to determine the best possible treatment. If you wish to receive care at HSS, please contact our Physician Referral Service at 877-606-1555 for further assistance.