Intolerance reactions to knee arthroplasty in patients with nickel/cobalt allergy and disappearance of symptoms after revision surgery with titanium-based endoprostheses.

Intolerance reactions to metal implants may present as dermatitis, impaired wound healing, effusions, pain or loosening. The clinical relevance of metal allergy in the differential diagnosis is often unclear and patients may even tolerate implants containing metals to which they are allergic. We present four patients with knee arthroplasty in whom after exclusion of infection or mechanical causes, a nickel/cobalt allergy led to replacement surgery with titanium-based prostheses. The subsequent alleviation of symptoms underlined the relevance and usefulness of allergological diagnostics in selected cases of complicated arthroplasty.

Perioperative Application of a Serum Protein Solution (Biseko(®)) After Proximal Femur Fracture of Elder Patients.

Fractures of the proximal femur are frequently seen in elderly people and will increase due to the demographic development of most industrialized countries. Early operation of dislocated fractures with either osteosynthesis or hemiprothesis has become a standard treatment for this type of injury. The high co-morbidity often leads to secondary complications like infections still resulting in a perioperative mortality rate of 11%. The perioperative infusion regime might influence the postoperative inflammatory response. Therefore Biseko(®), a serum protein solution, was compared to albumin and crystalloid infusion (Elomel). A total of 45 patients with proximal femur fractures were randomly assigned to either of the groups and received 500 ml of the infusion on 3 days starting from the day of operation. The Biseko(®) group showed significantly lower CRP levels, less infections and antibiotic treatment as well as a better clinical outcome referring to the TISS28 and APACHE Score. Concerning IL-6, IL-8, IL-10 and serum leukocytes no significant differences were observed. The result shows a beneficial influence of the serum protein solution Biseko(®) concerning the number of perioperative complications. The design of this study and the small number of patients does not yet allow any conclusion concerning the effectiveness of this treatment.