Alergijske reakcije na ortopedske implantate

master's thesis

• Title (english): Hypersensitivity reactions to orthopedic implants
• Author: Saša Jakšić
• Mentor: Suzana Ljubojević Hadžavdić (mentor)
• Committee member: Zrinka Bukvić Mokos (predsjednik povjerenstva)
• Committee member: Romana Čeović (član povjerenstva)
• Committee member: Suzana Ljubojević Hadžavdić (član povjerenstva)
• Granter: University of Zagreb; School of Medicine; (Department of Dermatology); Zagreb
• Defense date and country: 2018-07-13, Croatia
• Scientific / art field, discipline and subdiscipline: BIOMEDICINE AND HEALTHCARE; Clinical Medical Sciences; Dermatovenerology

Abstract

Alergijske reakcije na ortopedske implantate su rijedak uzrok zatajenja implantata.
Pouzdanih epidemioloških podataka iz ovog područja još uvijek nedostaje. Ortopedski implantati koji imaju nikal, kobalt i krom u svojem sastavu najčešće
uzrokuju reakcije preosjetljivosti. Patofiziološki mehanizam ovog stanja se odvija po principu odgođene preosjetljivosti, odnosno reakcije preosjetljivosti tipa IV. U
kliničkoj slici dominiraju nespecifični simptomi poput boli, otekline i smanjenog
opsega pokreta na mjestu implantata, no mogu se pojaviti i lokalizirane ili
generalizirane promjene na koži, odgođeno cijeljenje kosti i rana i neki rjeđi
simptomi. U dijagnostici se najprije moraju isključiti infekcija i mehaničke
nepravilnosti implantata. Zlatni standard za dokazivanje preosjetljivosti na implantate
je epikutani test. Osim toga, mogu se koristiti i in vitro testovi, od kojih se najčešće
upotrebljava test transformacije limfocita. Najučinkovitije liječenje je revizijska operacija s uklanjanjem alergenog implantata i zamjena s hipoalergenim. Prevencija
se sastoji od toga da se kod pacijenta koji u anamnezi navodi prijašnju preosjetljivost
na metale preoperativno učini epikutano testiranje na metale. Ako je test pozitivan, pacijentu se ugrađuje hipoalergeni implantat. Potrebno je provesti dodatna
istraživanja kako bi se izradile smjernice utemeljene na dokazima za dijagnostiku i liječenje pacijenata s ovim stanjem.

Abstract (english)

Hypersensitivity reactions to orthopedic implants are a rare cause of implant failure.
Epidemiological data regarding this issue is insufficient. Orthopedic implants containing nickel, cobalt, and chromium are the most frequent cause of
hypersensitivity reactions. The pathophysiological mechanism of this condition is a
type IV hypersensitivity reaction, also known as the delayed hypersensitivity
reaction. The most dominant symptoms are non-specific ones like pain, swelling, and
limited range of movement at the implant site. Localized or systemic skin changes,
as well as delayed bone and wound healing, can also occur, together with some less
frequent symptoms. During the diagnostic process, infection and mechanical
irregularities must be excluded first. The patch test is the golden standard for
diagnosing hypersensitivity reactions to orthopedic implants. In vitro tests can also
be used, and the lymphocyte transformation test is the most common one. The most
effective therapy is revision surgery where the allergenic implant is removed and a
hypoallergenic one is implanted instead. As a preventive measure, the patient's
history of metal hypersensitivity is obtained. If the patient reports previous metal
hypersensitivity, a preoperative patch test is done. If the test turns out to be positive,
a hypoallergenic implant is used in the following surgery. Additional scientific studies
have to be done in order to create evidence-based diagnostic and therapeutic
guidelines.

• Keywords: alergija na implantat; alergija na metale; alergijski kontaktni dermatitis; epikutani test; artroplastika
• Keywords (english): implant hypersensitivity; metal hypersensitivity; allergic contact dermatitis; patch test; arthroplasty
• Language: croatian
• URN:NBN: urn:nbn:hr:105:439899
• Study programme: Title: Medicine; Study programme type: university; Study level: integrated undergraduate and graduate; Academic / professional title: doktor/doktorica medicine (doktor/doktorica medicine)
• Type of resource: Text
• File origin: Born digital
• Access conditions: Open access
• Created on: 2019-10-17 08:42:13