Mr Chana says he routinely asks all of his patients whether they react to costume jewellery and if they are able to wear a watch with a stainless steel back. Research suggests a sensitivity reaction occurs in 0.2 per cent to 2 per cent of patients who have had a hip replacement.īut in those who have pre-existing reactions to nickel or other metals, the incidence rises to between 2 per cent to 4 per cent, says Mr Chana.Ī study published recently in the journal BMC Musculoskeletal Disorders suggested that given the high percentage of hypersensitivity to metals (up to 10 per cent of the population), particularly to nickel, and the presence of nickel in standard knee implants, it ought to be crucial to check a patient's sensitivity before surgery in order to prevent reactions. 'For example, it is possible that a wire inside the implant breaks, so the nickel inside has been exposed,' he adds. There are other possible causes too, adds Ashish Shetty, a consultant in pain medicine at University College London Hospitals. The delay in allergic reaction symptoms may be due to metal particles being released slowly from the implant, but which then go on to cause inflammatory reactions. 'This may be because they wear cheap jewellery which is made from nickel,' he says. That's because patients get 'sensitised' to react to a certain metal and women are more at risk of this than men, adds Mr Hart. People who get a nickel rash when they wear watches are more at risk of reacting to their implant, says Mr Chana. However, some implants contain separate parts made from different materials that can corrode and then cause hypersensitivity: the worst combination is when there is a titanium part next to a cobaltchromium part - found in some hip replacements. But, according to research, those made of nickel, cobalt and chromium are most likely to elicit a reaction titanium is better tolerated by the body. 'I have seen patients who have experienced a delayed hypersensitivity reaction and rejected an implant after eight years of having it in,' adds Alister Hart, a consultant hip and knee surgeon at the Royal National Orthopaedic Hospital. 'Some patients are very sensitive to small amounts of metal.' People have a 'spectrum of responses depending on their sensitivity,' adds Mr Chana. 'I had gone all that time using the stimulator with reasonable success, but suddenly the thing that was meant to help me actually left me with even more pain. Yet in September 2015, after repeated hospital visits, Pat was told her body was in effect rejecting the implant, and she needed surgery to take it out. Pat went back to hospital, but her consultant initially could not figure out exactly what was happening. ![]() 'I started to feel really rundown and hot all the time and the terrible pain returned.' 'I could always feel the implant under the skin, but two years after having it put in, the area became tender and sore,' recalls Pat, who lives with husband Gerry, 77. ![]() All rights reserved.Pat Taylor had tried numerous treatments over the years to help find some relief for her chronic back pain - but none proved successfulīut last year, just over two years after she had the implant fitted, the 72-year-old from Bury St Edmunds, Suffolk, was back in hospital having it removed - not because it didn't work, but because her body had started to reject it. Published by Oxford University Press for the Infectious Diseases Society of America. ![]() Several preventive strategies can be incorporated in surgical practice to reduce the risk of SCS infection.ĭiagnosis infection management prevention spinal cord stimulator. Duration of antimicrobial therapy depends on severity of clinical presentation and presence or absence of associated complications. While superficial surgical site infection following SCS implant may be treated with antibiotic therapy alone, deep infection involving implant warrants device removal to achieve cure. Early recognition of SCS-related infections and associated complications is based on clinical suspicion, laboratory testing, and appropriate diagnostic imaging. However, delay in diagnosis may lead to complications such as meningitis, epidural abscess, and/or vertebral osteomyelitis. Most SCS infections present as generator pocket infection. Infection is one of the most dreaded complications related to SCS implantation and may prevent patients from receiving adequate pain treatment, adding to the initial cost and disability. Spinal cord stimulation (SCS) is the most utilized invasive electrical neuromodulation treatment for the management of refractory chronic pain syndromes.
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