{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T20:33:39Z","timestamp":1791405219603,"version":"4.3.3"},"reference-count":58,"publisher":"Wiley","issue":"2","license":[{"start":{"date-parts":[[2011,9,29]],"date-time":"2011-09-29T00:00:00Z","timestamp":1317254400000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/onlinelibrary.wiley.com\/termsAndConditions#vor"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Contact Dermatitis"],"published-print":{"date-parts":[[2012,2]]},"abstract":"<jats:p>There are concerns about the induction of metal allergy with second\u2010generation metal\u2010on\u2010metal prostheses, and the role that this may play in the development of complications such as \u2018pseudotumours\u2019 or failure of the implant. In this review, we attempt to set out the current knowledge on this subject. From a review of the literature, it is apparent that the first\u2010generation metal\u2010on\u2010metal replacement hips did cause metal sensitization, and that joint failure was associated with this, although it is still not clear which one led to the other. Highly engineered second\u2010generation metal\u2010on\u2010metal arthroplasties used in joint resurfacings are now increasingly employed. Several studies have recently shown an association between metal sensitization and peri\u2010implant hypersensitivity reactions and implant loosening and failure, although the overall risk appears to be low. The pragmatic approach adopted by most contact dermatologists for patients known to be allergic to nickel, cobalt or chromium and who require joint replacement is to recommend prostheses made of titanium\u2010based alloys. Patch testing continues to be a useful tool as laboratory investigations for metal hypersensitivity continue to emerge. The development of guidelines on the management of patients receiving metal\u2010on\u2010metal arthroplasties suspected of being metal\u2010allergic is desirable.<\/jats:p>","DOI":"10.1111\/j.1600-0536.2011.01970.x","type":"journal-article","created":{"date-parts":[[2011,9,30]],"date-time":"2011-09-30T10:47:16Z","timestamp":1317379636000},"page":"55-62","source":"Crossref","is-referenced-by-count":43,"title":["Metal allergy and second\u2010generation metal\u2010on\u2010metal arthroplasties"],"prefix":"10.1111","volume":"66","author":[{"given":"Philippa J.","family":"Cousen","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David J.","family":"Gawkrodger","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"311","published-online":{"date-parts":[[2011,9,29]]},"reference":[{"key":"e_1_2_4_2_2","doi-asserted-by":"publisher","DOI":"10.1046\/j.1365-2133.2003.05404.x"},{"key":"e_1_2_4_3_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.2009.09325.x"},{"key":"e_1_2_4_4_2","doi-asserted-by":"publisher","DOI":"10.1002\/1097-4636(200009)53:5<480::AID-JBM6>3.0.CO;2-B"},{"key":"e_1_2_4_5_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1365-2133.2009.09526.x"},{"key":"e_1_2_4_6_2","doi-asserted-by":"publisher","DOI":"10.1243\/095441105X68971"},{"key":"e_1_2_4_7_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.4.5993.376"},{"key":"e_1_2_4_8_2","doi-asserted-by":"publisher","DOI":"10.1136\/bmj.4.5993.374"},{"key":"e_1_2_4_9_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0536.1976.tb02986.x"},{"key":"e_1_2_4_10_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-197759070-00004"},{"key":"e_1_2_4_11_2","doi-asserted-by":"crossref","first-page":"626","DOI":"10.1302\/0301-620X.56B4.626","article-title":"Metal sensitivity as a cause of bone necrosis and loosening of the prosthesis in total joint replacement.","volume":"56","author":"Evans E M","year":"1974","journal-title":"J Bone Joint Surg Br"},{"key":"e_1_2_4_12_2","doi-asserted-by":"publisher","DOI":"10.2106\/00004623-197759020-00004"},{"key":"e_1_2_4_13_2","doi-asserted-by":"publisher","DOI":"10.1097\/00003086-199608001-00003"},{"key":"e_1_2_4_14_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0536.1976.tb03044.x"},{"key":"e_1_2_4_15_2","doi-asserted-by":"publisher","DOI":"10.1111\/j.1600-0536.1985.tb02581.x"},{"key":"e_1_2_4_16_2","doi-asserted-by":"crossref","first-page":"502","DOI":"10.1302\/0301-620X.62B4.7430234","article-title":"Metal sensitivity in patients undergoing hip replacement. 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