{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,2]],"date-time":"2026-09-02T00:25:51Z","timestamp":1788308751906,"version":"build-2803163510"},"reference-count":48,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"8","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2017,4,19]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Recent studies indicate that females demonstrate an increased risk of experiencing adverse local tissue reactions, aseptic loosening, and revision after primary metal-on-metal hip resurfacing arthroplasty compared with males; the underlying biological mechanisms responsible for sex discrepancies in implant failure remain unclear. In addition to anatomical and biomechanical sex differences, there may be inherent immunological disparities that predispose females to more aggressive adaptive immune reactivity to implant debris, i.e., metal sensitivity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In this retrospective study, we analyzed sex-associated rates and levels of metal sensitization in 1,038 male and 1,575 female subjects with idiopathic joint pain following total joint arthroplasty (TJA) who were referred for in vitro metal-sensitivity testing.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Females demonstrated a significantly higher rate and severity of metal sensitization compared with males. The median lymphocyte stimulation index (SI) among males was 2.8 (mean, 5.4; 95% confidence interval [CI], 4.9 to 6.0) compared with 3.5 (mean, 8.2; 95% CI, 7.4 to 9.0) among females (p &lt; 0.05). Forty-nine percent of females had an SI of \u22654 (reactive) compared with 38% of males, and the implant-related level of pain was also significantly (p &lt; 0.0001) higher among females (mean, 6.8; 95% CI, 6.6 to 6.9) compared with males (mean, 6.1; 95% CI, 6.0 to 6.3).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>In a select group of patients who had joint pain following TJA and no evidence of infection and who were referred for metal-sensitivity testing, females exhibited a higher level of pain and demonstrated a higher rate and severity (as measured by lymphocyte SI) of metal sensitization compared with males.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Prognostic\n                      <jats:underline>Level III<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.16.00720","type":"journal-article","created":{"date-parts":[[2017,4,19]],"date-time":"2017-04-19T09:51:40Z","timestamp":1492595500000},"page":"621-628","source":"Crossref","is-referenced-by-count":56,"title":["Females with Unexplained Joint Pain Following Total Joint Arthroplasty Exhibit a Higher Rate and Severity of Hypersensitivity to Implant Metals Compared with Males"],"prefix":"10.2106","volume":"99","author":[{"given":"Marco S.","family":"Caicedo","sequence":"first","affiliation":[{"name":"Orthopedic Analysis, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Edward","family":"Solver","sequence":"additional","affiliation":[{"name":"Orthopedic Analysis, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Latasha","family":"Coleman","sequence":"additional","affiliation":[{"name":"Orthopedic Analysis, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joshua J.","family":"Jacobs","sequence":"additional","affiliation":[{"name":"Departments of Orthopedic Surgery (J.J.J. and N.J.H.) and Immunology (N.J.H.), Rush University Medical Center, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nadim J.","family":"Hallab","sequence":"additional","affiliation":[{"name":"Orthopedic Analysis, Chicago, Illinois"},{"name":"Departments of Orthopedic Surgery (J.J.J. and N.J.H.) and Immunology (N.J.H.), Rush University Medical Center, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"Suppl 2","key":"bib1-20230714","doi-asserted-by":"crossref","first-page":"117","DOI":"10.2106\/JBJS.J.00807","article-title":"A prospective study of 80,000 total joint and 5000 anterior cruciate ligament reconstruction procedures in a community-based registry in the United States","volume":"92","author":"Paxton","year":"2010","journal-title":"J Bone Joint Surg Am."},{"issue":"15","key":"bib2-20230714","doi-asserted-by":"crossref","first-page":"1560","DOI":"10.1001\/jama.2011.478","article-title":"Clinical characteristics and outcomes of Medicare patients undergoing total hip arthroplasty, 1991-2008","volume":"305","author":"Cram","year":"2011","journal-title":"JAMA."},{"issue":"4","key":"bib3-20230714","doi-asserted-by":"crossref","first-page":"780","DOI":"10.2106\/00004623-200704000-00012","article-title":"Projections of primary and revision hip and knee arthroplasty in the United States from 2005 to 2030","volume":"89","author":"Kurtz","year":"2007","journal-title":"J Bone Joint Surg Am."},{"issue":"6","key":"bib4-20230714","doi-asserted-by":"crossref","first-page":"435","DOI":"10.1001\/jamainternmed.2013.3271","article-title":"Sex and risk of hip implant failure: assessing total hip arthroplasty outcomes in the United States","volume":"173","author":"Inacio","year":"2013","journal-title":"JAMA Intern Med."},{"issue":"8","key":"bib5-20230714","doi-asserted-by":"crossref","first-page":"1076","DOI":"10.1302\/0301-620X.97B8.35170","article-title":"The epidemiology of revision total knee and hip arthroplasty in England and Wales: a comparative analysis with projections for the United States. 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