O100 The effect of nickel hypersensitivity on outcome of total knee arthroplasty and value of skin patch testing: a systematic review

Abstract Introduction Aims of the systematic review were to assess sensitising potential TKA, explore relationship between Nickel hypersensitivity and clinical outcomes, evaluate utility skin patch testing pre- and/or post-operatively. Methods A literature search was performed through EMBASE, Medline PubMed databases. Articles screened independently by two authors. Levels Evidence assessed using OCEBM criteria, quality MINORS Cochrane risk-of-bias tools. Results Twenty studies met eligibility reporting on 1354 knee arthroplasties. Prevalence ranged from 0% 87.5%. Only one study which compared prevalence in same patient group before after surgery noted newly positive test reactions 4.1%. Three reported lower post-operative patients pre-operative patients. Seven suggested might cause complications; six did not support any relationship. recommended with history metal allergy; nine concluded may be valuable Conclusion Patients undergoing TKA do seem at increased risk developing hypersensitivity, however there is conflicting evidence that established are more likely experience adverse outcomes. Patch remains gold standard diagnostic method; suggests performing this pre-operatively allergy aid selection most appropriate prosthesis, postoperatively once common causes implant failure have been excluded, since removal or revision hypoallergenic implants alleviate symptoms. Take-home message total arthroplasty an nickel mixed preoperatively a post-operatively only excluded.