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Joint Replacement Problems

Study Validates Nickel Blood Test

Positive tests for nickel and cobalt allergy, with negative reactions to other metals.Of the one million joints replaced yearly in the U.S., about ten percent of them will fail. Typical symptoms may include:

  • Chronic pain and swelling
  • Skin inflammation and dermatitis
  • Impaired wound healing
  • Chronic joint effusions
  • Itching or burning
  • Hardware loosening

When infection and biomechanical issues have been ruled out, metal or bone cement allergy may be the cause.


Karin Pacheco, MD, MSPH, director of the MetAlls Clinic at National Jewish Health, states, “We have seen more than 230 patients over the last two years for unexplained chronic problems after joint replacement. We found that about half of them were allergic to either the metal in the joint hardware or to the bone cement used to adhere the prosthesis.”

The MetAlls Clinic offers individualized diagnostics for metal and bone cement allergy. The patch test panels include a selection of most metals used in orthopedic hardware, as well as the different components of bone cement. The nickel lymphocyte proliferation test has been validated against patch testing. In October, a summary of the study and results of the NiLPT validation were submitted by Dr. Pacheco for peer review and publication.


Indications for Referral

  • Unexplained chronic pain and/or swelling following a joint replacement
  • Allergy information required for selection of index hardware, important for the patient with a prior history of metal or artificial nail sensitivity

To refer a patient directly to the MetAlls Clinic at National Jewish Health, call Physician Line at 800.652.9555, choose option 2 and request extension 1723.