Does metal allergy have relevance in patients undergoing arthroplasty—an electronic survey of surgeon attitudes
Notice bibliographique
Résumé
Background: Metallic implants are an integral part of the practice of orthopaedic surgery. Metal hypersensitivity is reported to be from 10−17% of the general population. No consensus exists on how to screen or what changes in treatment plans should be implemented when reported sensitivities to metals exist. Literature review suggests that preoperative testing may influence surgical practice. This study was designed to gain insight to the experience of orthopaedic surgeons as it relates to metal allergies to metallic orthopaedic implants and to examine the trends in screening and evaluating patients who have sensitivities to metals to determine how this data influences treatment. Methods: An online survey of orthopaedic surgeons’ experiences and opinions on the prevalence, screening protocols, and treatment adjustments made when metal hypersensitivity is suspected was performed. A 35-question survey was distributed via orthopaedic surgery specialty societies, orthopaedic surgery departments, and state orthopaedic societies’ email lists. The survey was performed by a commercially available online survey company, which provided data acquisition and analysis. Results: A total of 230 responses were obtained from May 15, 2015 through December 31, 2015. Respondents were primarily from the United States with a small contribution from Canada and other countries. All regions of the United States and all orthopedic specialties were represented. A quarter of respondents have experience with metal allergy to an implant. Most orthopaedic surgeons (69%) believed that metal allergies occur with orthopedic implants, while 18% did not believe that metal allergies occur. Nickel, cobalt, and chromium allergies were most commonly seen. Consultation with an allergist/dermatologist was primarily used for diagnosis. Revision was listed as the first choice of treatment in 47% of respondents, while observation was listed as first choice by 33%. Most surgeons (59%) did not ask patients about metal allergy history. Only a quarter of patient questionnaires inquired about metal allergy. The majority (59%) altered their implant choice with a mild reaction to testing, whereas 29% did not. With a moderate reaction, 72% altered their implant. When the reaction was severe, 64% altered their implant, 12% obtained a second opinion, and 6% did not alter their implant. Conclusions: Orthopaedic surgeons vary in their level of confidence on whether metal allergy to orthopaedic implants exist. Most surgeons believe in metal allergy, but a sizable number do not believe. The prevalence of reported metal allergy to an implant was low. Surgeons tend to alter their choice of implant more frequently as the reaction becomes more severe. Observation and revision surgery are frequently used to treat an allergic reaction. Allergy/dermatology consults are used to diagnose metal allergy, yet a minority of orthopaedic surgeons inquire about metal hypersensitivity in their patients. Greater awareness of a history of hypersensitivity may prevent patient exposure to implants containing metals that they may react to. More evidence is needed to establish a connection between metal sensitivity and the occurrence of pain and implant loosening following arthroplasty procedures.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,002 | 0,013 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,000 | 0,001 |
| Bibliométrie | 0,002 | 0,002 |
| Études des sciences et des technologies | 0,000 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,000 | 0,001 |
| Intégrité de la recherche | 0,001 | 0,001 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,002 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».