Metals in the alloys used for orthopedic implants:
(1) aluminum (in titanium alloy)
(2) chromium (in stainless steel, cobalt alloy)
(3) cobalt (in cobalt alloy)
(4) molybdenum (in stainless steel, cobalt alloy)
(5) nickel (in stainless steel, cobalt alloy)
(6) titanium (in titanium alloy)
(7) vanadium (in titanium alloy)
Allergic manifestations may include:
(1) eczematous dermatitis
(2) generalized urticaria
(3) vasculitis
Findings adjacent to the implant may include:
(1) corrosion of the implant
(2) metallosis (discoloration of the surrounding tissues)
(3) excessive fibrosis around the prosthesis
(4) patchy muscle necrosis
Diagnostic features:
(1) presence of allergic manifestation
(2) onset or worsening of symptoms after the orthopedic implant
(3) spontaneous reversal of allergic manifestation on removal of the implant
(4) positive patch test or recurrence of symptoms on exposure to the implicated metal
Differential diagnosis:
(1) allergy to prophylactic antibiotics
(2) reaction to some other component of the implant
