{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,25]],"date-time":"2026-09-25T18:40:20Z","timestamp":1790361620636,"version":"4.1.0"},"reference-count":85,"publisher":"Wiley","issue":"3","license":[{"start":{"date-parts":[[2023,12,26]],"date-time":"2023-12-26T00:00:00Z","timestamp":1703548800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["onlinelibrary.wiley.com"],"crossmark-restriction":true},"short-container-title":["Contact Dermatitis"],"published-print":{"date-parts":[[2024,3]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:p>After almost three\u2010quarters of a century during which contact dermatologists have often struggled to comprehend the relationship between metal allergy and failure of metal\u2010alloy containing implant, it is possible to say that a relationship does exist, particularly for cobalt and chromium, but also for nickel. There is still debate as to whether allergy develops as a consequent of failure but thenceforth contributes to it, or whether sensitisation starts first and induces failure secondarily\u2014opinion probably favours the first. Metal\u2010on\u2010polypropylene articulations were associated with few metal allergic problems but now are less favoured by orthopaedists due to plastic wear products causing osteolysis and pseudotumour formation through local inflammation. New metal alloys are regularly being introduced such that interested dermatologists need to stay on top of the situation. The jury is still out as to whether the recent favouring of titanium\u2010containing alloys will confirm them to be more inert allergenically. Case reports do show some clinical reactions to titanium\u2010containing implants and patch test series have inferred sometimes quite a high background rate of allergy, but interpretation must be tempered by the awareness that titanium salts on patch testing have a tendency to cause irritant reactions. Blood monitoring of metal ion values is now recommended in certain situations after joint replacement and increasing levels may be an indication that allergy with joint failure can develop, in which case patch testing is indicated, and suggested series are available. Predictive patch testing, whilst generally not recommended in the past, has been introduced into some protocols often by non\u2010dermatologists, such that it is now needed for temporo\u2010mandibular joint and Nuss bar insertion, and it can be anticipated that this may become more commonplace in the future. One of the major current deficits for patch testers is standardised guidance on which preparation or preparations to use for suspected titanium allergy. One suggestion is 0.5% titanium sulphate in petrolatum, though experience in at least one centre suggests the use of a battery of titanium salts might be desirable.<\/jats:p>","DOI":"10.1111\/cod.14481","type":"journal-article","created":{"date-parts":[[2023,12,27]],"date-time":"2023-12-27T07:28:27Z","timestamp":1703662107000},"page":"201-210","update-policy":"https:\/\/doi.org\/10.1002\/crossmark_policy","source":"Crossref","is-referenced-by-count":13,"title":["The contribution of metal allergy to the failure of metal alloy implants, with special reference to titanium: Current knowledge and controversies"],"prefix":"10.1111","volume":"90","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-4233-1321","authenticated-orcid":false,"given":"Chenghao","family":"Huang","sequence":"first","affiliation":[{"name":"Calderdale Royal Hospital Calderdale and Huddersfield NHS Foundation Trust  Halifax UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0003-8717-1602","authenticated-orcid":false,"given":"Shu Yu Vanessa","family":"Chiang","sequence":"additional","affiliation":[{"name":"Calderdale Royal Hospital Calderdale and Huddersfield NHS Foundation Trust  Halifax UK"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-6863-7011","authenticated-orcid":false,"given":"David J.","family":"Gawkrodger","sequence":"additional","affiliation":[{"name":"Department of Dermatology Royal Hallamshire Hospital, University of Sheffield  Sheffield UK"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2023,12,26]]},"reference":[{"key":"e_1_2_15_2_1","unstructured":"National Joint Registry.National Joint Registry 18th Annual Report.2021. Accessed December 19 2023.https:\/\/www.hqip.org.uk\/resource\/njr-18th-annual-report-2021\/"},{"key":"e_1_2_15_3_1","volume-title":"StatPearls","author":"Tapscott DC","year":"2023"},{"key":"e_1_2_15_4_1","doi-asserted-by":"publisher","DOI":"10.1001\/archderm.1981.01650090036021"},{"key":"e_1_2_15_5_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u20100536.1993.tb03427.x"},{"key":"e_1_2_15_6_1","doi-asserted-by":"publisher","DOI":"10.2478\/v10001\u2010006\u20100025\u20106"},{"key":"e_1_2_15_7_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJSA.02039pp"},{"key":"e_1_2_15_8_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.rdc.2006.12.008"},{"key":"e_1_2_15_9_1","doi-asserted-by":"publisher","DOI":"10.1007\/s11999\u2010014\u20103540\u2010y"},{"key":"e_1_2_15_10_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u20100536.2011.01970.x"},{"key":"e_1_2_15_11_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.4.5993.374"},{"key":"e_1_2_15_12_1","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.4.5993.376"},{"key":"e_1_2_15_13_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-197759070-00004"},{"key":"e_1_2_15_14_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jcot.2013.11.005"},{"key":"e_1_2_15_15_1","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365\u20102133.2003.05404.x"},{"key":"e_1_2_15_16_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.62B4.7430234"},{"key":"e_1_2_15_17_1","doi-asserted-by":"publisher","DOI":"10.2106\/JBJS.J.01612"},{"key":"e_1_2_15_18_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.81B1.0810046"},{"key":"e_1_2_15_19_1","doi-asserted-by":"publisher","DOI":"10.1007\/978\u20103\u20107985\u20101635\u20109_12"},{"key":"e_1_2_15_20_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.biomaterials.2007.11.038"},{"key":"e_1_2_15_21_1","doi-asserted-by":"publisher","DOI":"10.21037\/aoj.2019.10.01"},{"key":"e_1_2_15_22_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.anai.2018.03.003"},{"key":"e_1_2_15_23_1","unstructured":"MihalkoWM GoodmanSB AminiM HallabN.Metal sensitivity testing and associated total joint outcomes. Scientific exhibition presented at the American Academy of Orthopaedic Surgeons Annual Meeting.2013."},{"issue":"11","key":"e_1_2_15_24_1","doi-asserted-by":"crossref","first-page":"889","DOI":"10.1111\/j.1610-0387.2011.07671.x","article-title":"New\u201d techniques for more sensitive patch testing?","volume":"9","author":"Dickel H","year":"2011","journal-title":"JDDG J Dtsch Dermatol Ges"},{"key":"e_1_2_15_25_1","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOS\u2010D\u201014\u201000290"},{"key":"e_1_2_15_26_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0536.2011.01971.x"},{"key":"e_1_2_15_27_1","doi-asserted-by":"publisher","DOI":"10.1159\/000237456"},{"key":"e_1_2_15_28_1","doi-asserted-by":"publisher","DOI":"10.1186\/s12891\u2010016\u20101342\u2010y"},{"key":"e_1_2_15_29_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-200103000-00017"},{"key":"e_1_2_15_30_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.94B8.28135"},{"key":"e_1_2_15_31_1","doi-asserted-by":"publisher","DOI":"10.1186\/1749\u2010799X\u20108\u201012"},{"key":"e_1_2_15_32_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.92B1.22770"},{"issue":"4","key":"e_1_2_15_33_1","first-page":"387","article-title":"The effects of metal corrosion debris on immune system cells","volume":"83","author":"Donati ME","year":"1998","journal-title":"Chir Organi Mov"},{"key":"e_1_2_15_34_1","doi-asserted-by":"publisher","DOI":"10.1097\/DER.0b013e31829cb113"},{"key":"e_1_2_15_35_1","doi-asserted-by":"publisher","DOI":"10.1155\/2012\/749561"},{"key":"e_1_2_15_36_1","doi-asserted-by":"publisher","DOI":"10.1038\/s41598\u2010020\u201061875\u20106"},{"key":"e_1_2_15_37_1","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-199810000-00006"},{"key":"e_1_2_15_38_1","doi-asserted-by":"publisher","DOI":"10.1007\/s00402\u2010010\u20101056\u20109"},{"key":"e_1_2_15_39_1","unstructured":"Medicines and Healthcare products Regulatory Agency.All metal\u2010on\u2010metal (MoM) hip replacements: updated advice for follow\u2010up of patients.2017. Accessed September 8 2023.https:\/\/www.gov.uk\/drug\u2010device\u2010alerts\/all\u2010metal\u2010on\u2010metal\u2010mom\u2010hip\u2010replacements\u2010updated\u2010advice\u2010for\u2010follow\u2010up\u2010of\u2010patients"},{"key":"e_1_2_15_40_1","doi-asserted-by":"publisher","DOI":"10.1111\/cod.12565"},{"key":"e_1_2_15_41_1","doi-asserted-by":"publisher","DOI":"10.4103\/0019\u20105154.143526"},{"key":"e_1_2_15_42_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u20100536.2006.00931.x"},{"key":"e_1_2_15_43_1","doi-asserted-by":"publisher","DOI":"10.3390\/ma14185239"},{"key":"e_1_2_15_44_1","doi-asserted-by":"publisher","DOI":"10.1111\/clr.13305"},{"key":"e_1_2_15_45_1","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/910156"},{"key":"e_1_2_15_46_1","doi-asserted-by":"publisher","DOI":"10.1302\/0301\u2010620X.73B1.1991768"},{"key":"e_1_2_15_47_1","doi-asserted-by":"publisher","DOI":"10.3181\/0810\u2010RM\u2010304"},{"key":"e_1_2_15_48_1","doi-asserted-by":"publisher","DOI":"10.4236\/health.2010.24045"},{"key":"e_1_2_15_49_1","doi-asserted-by":"publisher","DOI":"10.5114\/ada.2023.127640"},{"key":"e_1_2_15_50_1","doi-asserted-by":"publisher","DOI":"10.5301\/jabfm.5000243"},{"key":"e_1_2_15_51_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1440\u20100960.1996.tb01050.x"},{"key":"e_1_2_15_52_1","doi-asserted-by":"publisher","DOI":"10.2131\/jts.35.107"},{"key":"e_1_2_15_53_1","doi-asserted-by":"publisher","DOI":"10.1111\/exd.12121"},{"key":"e_1_2_15_54_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u20100536.1984.tb00986.x"},{"key":"e_1_2_15_55_1","doi-asserted-by":"publisher","DOI":"10.1111\/cod.13010"},{"key":"e_1_2_15_56_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600\u20100501.2008.01544.x"},{"key":"e_1_2_15_57_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0002\u20109610(98)00197\u20104"},{"key":"e_1_2_15_58_1","doi-asserted-by":"publisher","DOI":"10.3389\/fbioe.2019.00170"},{"key":"e_1_2_15_59_1","doi-asserted-by":"publisher","DOI":"10.5435\/JAAOSGlobal\u2010D\u201020\u201000200"},{"key":"e_1_2_15_60_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tox.2014.10.016"},{"key":"e_1_2_15_61_1","doi-asserted-by":"publisher","DOI":"10.1155\/2015\/137287"},{"key":"e_1_2_15_62_1","doi-asserted-by":"publisher","DOI":"10.1002\/jbm.a.32390"},{"key":"e_1_2_15_63_1","doi-asserted-by":"publisher","DOI":"10.1002\/jbm.a.32914"},{"key":"e_1_2_15_64_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.mser.2014.01.001"},{"key":"e_1_2_15_65_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.pnsc.2014.08.014"},{"key":"e_1_2_15_66_1","doi-asserted-by":"publisher","DOI":"10.1177\/1464420719882458"},{"key":"e_1_2_15_67_1","doi-asserted-by":"publisher","DOI":"10.23822\/EurAnnACI.1764\u20101489.141"},{"key":"e_1_2_15_68_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.bjoms.2013.06.009"},{"key":"e_1_2_15_69_1","doi-asserted-by":"publisher","DOI":"10.1055\/a\u20101868\u20106224"},{"key":"e_1_2_15_70_1","doi-asserted-by":"publisher","DOI":"10.1111\/all.15149"},{"key":"e_1_2_15_71_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jaci.2022.12.470"},{"key":"e_1_2_15_72_1","doi-asserted-by":"publisher","DOI":"10.1111\/cod.13940"},{"key":"e_1_2_15_73_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.tox.2017.10.014"},{"key":"e_1_2_15_74_1","doi-asserted-by":"publisher","DOI":"10.1111\/cod.13666"},{"key":"e_1_2_15_75_1","doi-asserted-by":"publisher","DOI":"10.15041\/jsedp.13.39"},{"key":"e_1_2_15_76_1","doi-asserted-by":"publisher","DOI":"10.4103\/ccd.ccd_773_20"},{"key":"e_1_2_15_77_1","doi-asserted-by":"publisher","DOI":"10.7759\/cureus.7109"},{"key":"e_1_2_15_78_1","doi-asserted-by":"publisher","DOI":"10.1016\/j.jpor.2015.12.004"},{"key":"e_1_2_15_79_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022\u20103913(12)60163\u20102"},{"key":"e_1_2_15_80_1","doi-asserted-by":"publisher","DOI":"10.1111\/j.1540\u20108159.2006.00535.x"},{"key":"e_1_2_15_81_1","doi-asserted-by":"publisher","DOI":"10.1111\/cod.12985"},{"key":"e_1_2_15_82_1","doi-asserted-by":"publisher","DOI":"10.1111\/cod.13997"},{"issue":"5","key":"e_1_2_15_83_1","first-page":"691","article-title":"Revision of a tibial baseplate using a customized oxinium component in a case of suspected metal allergy. A case report","volume":"77","author":"Van Opstal N","year":"2011","journal-title":"Acta Orthop Belg"},{"key":"e_1_2_15_84_1","doi-asserted-by":"publisher","DOI":"10.1016\/S0022\u20103913(08)60233\u20104"},{"key":"e_1_2_15_85_1","doi-asserted-by":"publisher","DOI":"10.1111\/jopr.12136"},{"issue":"1","key":"e_1_2_15_86_1","first-page":"31","article-title":"Hypersensitivity to titanium: clinical and laboratory evidence","volume":"27","author":"M\u00fcller K","year":"2006","journal-title":"Neuro Endocrinol Lett"}],"container-title":["Contact Dermatitis"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/pdf\/10.1111\/cod.14481","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2024,2,12]],"date-time":"2024-02-12T16:22:25Z","timestamp":1707754945000},"score":1,"resource":{"primary":{"URL":"https:\/\/onlinelibrary.wiley.com\/doi\/10.1111\/cod.14481"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2023,12,26]]},"references-count":85,"journal-issue":{"issue":"3","published-print":{"date-parts":[[2024,3]]}},"alternative-id":["10.1111\/cod.14481"],"URL":"https:\/\/doi.org\/10.1111\/cod.14481","archive":["Portico"],"relation":{},"ISSN":["0105-1873","1600-0536"],"issn-type":[{"value":"0105-1873","type":"print"},{"value":"1600-0536","type":"electronic"}],"subject":[],"published":{"date-parts":[[2023,12,26]]},"assertion":[{"value":"2023-09-25","order":0,"name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-11-29","order":1,"name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}},{"value":"2023-12-26","order":2,"name":"published","label":"Published","group":{"name":"publication_history","label":"Publication History"}}]}}