Type IV Cell-Mediated Hypersensitivity Reaction Caused by Titanium Implant Following Double Calcaneal Osteotomy and First Metatarsal-Cuneiform Arthrodesis: A Case Report and Review of the Literature

Because of their inert character and desired biocompatibility, titanium implants have been universally accepted as safer alternatives to the conventional stainless steel orthopedic implants; however, recent emergence of type IV hypersensitivity reactions to titanium have included eczema, contact der...

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Bibliographic Details
Published in:The Journal of foot and ankle surgery 2019-09, Vol.58 (5), p.974-979
Main Authors: Razzante, Mark C., Ehredt, Duane J., Clougherty, Coleman O., Kriger, Stephen J., Menninger, Brennan A., Behan Dionisopoulos, Shontal, Bhakta, Parth J., Bruning, Nicholas G.
Format: Article
Language:English
Subjects:
Adult
Arthrodesis - adverse effects
Arthrodesis - instrumentation
Female
Flatfoot - surgery
hardware allergy
Humans
Hypersensitivity, Delayed - diagnosis
Hypersensitivity, Delayed - etiology
Hypersensitivity, Delayed - therapy
Metatarsal Bones - surgery
Osteotomy - adverse effects
Tarsal Bones - surgery
Titanium - adverse effects
titanium allergy
titanium alloy
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Summary:Because of their inert character and desired biocompatibility, titanium implants have been universally accepted as safer alternatives to the conventional stainless steel orthopedic implants; however, recent emergence of type IV hypersensitivity reactions to titanium have included eczema, contact dermatitis, a prolonged febrile state, sterile osteonecrosis, and impaired fracture and wound healing. This report presents a patient with postoperative incision dehiscence and devascularization of surfaces in contact with titanium hardware after undergoing a double calcaneal osteotomy and a first metatarsal-cuneiform arthrodesis using titanium alloy implants. Titanium hypersensitivity was confirmed in this case through standard allergy patch testing by a board-certified immunologist. Complete healing occurred after diagnosis of the titanium allergy and hardware explant. To our knowledge, this is one of a few known allergies to titanium implants after foot and ankle surgery.
ISSN:1067-2516
1542-2224
DOI:10.1053/j.jfas.2018.11.031