Table 3 Characteristics of individual patient groups in each study with sample size (n), mean age (range or SD), number of females (proportion) and type of TKA implant received

Atanaskova Mesinkovska et al. [24]

Preop patients with potential metal hypersensitivity before implantation of an orthopaedic metal device

31

56.1 (± 15.4)

23 (74%)

-

Postop patients with potential metal hypersensitivity after implantation of an orthopedic metal device

41

56.8 (± 16.5)

23 (56%)

NR

Carlsson and Möller [25]

Patients with contact allergy to Chromium, Cobalt and/or Nickel (verified by patch test preop) followed up after implantation of various metallic orthopedic devices (3 TKA, 15 other orthopedic implants) containing metal to which they were allergic

18

NR

NR

2 patients – CrCoNi

1 patient – CoCr

Carossino et al. [28]

Control group – no implant, no skin/immunological/metabolic or chronic disease

9

NR

NR

-

Patients awaiting TKA with documented clinical history of metal allergy and hypersensitivity reactions

8

NR

NR

-

Postop TKA patients with pain with referred metal allergy

11

NR

NR

NR

Postop TKA patients with pain with no referred metal allergy

11

NR

NR

NR

Desai et al. [29]

Postop TKA patients

233

59.6 (30–78)

149 (64%)

NR

Frigerio et al. [30]

TKA patients assessed pre- and postoperatively

52

NR

NR

33 patients – Femur: CoCrMo; Tibia: TiAlV

10 patients—CoCrMo

9 patients—TiAlV

THA patients assessed pre- and postoperatively

48

NR

NR

-

Granchi et al. [7]

Control group – no implant, candidates for TKA

20

65.2 (42–84)

14 (71%)

-

Postop TKA patients with stable implant

27

66.1 (42–84)

22 (82%)

23 patients – Femur: CoCrMo; Tibia: TiAlV

3 patients—CoCrMo

1 patient—TiAlV

Postop TKA patients with loosened implant

47

70.4 (57–79)

31 (66%)

27 patients – Femur: CoCrMo; TiAlV

16 patients—CoCrMo

2 patients—TiAlV

2 patients—unknown

Guenther et al. [31]

Historic database patients with preoperative known sensitisation to Chromium, Cobalt, Nickel, or cement component who underwent revision knee (n = 14) and hip (n = 3) arthroplasty due to a potential allergic reaction

17

58.2 (± 9.8)

17 (100%)

7 patients—unknown bicondylar surface replacement

3 patients – CoCrMo, UHMWPE

2 patients – CoCrMo, TiAlVa, UHMWPE

1 patient – OxZr

1 patient—CoCr, UHMWPE

Innocenti et al. [32]

Preop TKA patients with referred or suspected metal allergy receiving a non-allergenic implant

24

72.9 (54–86)

17 (71%)

Femur: OxZr; Tibia: All-polyethylene

Kitagawa et al. [26]

Patients before and after TKA with CoCr or OxZr implants

48

NR (64–89)

42 (88%)

25 patients—Femur: CoCr; Tibia: TiAlVa; Polyethylene insert

22 patients—Femur: OxZr; Tibia: TiAlVa; Polyethylene insert

1 patient—ceramic implant

Kręcisz et al. [27]

Preop TKA patients

21

NR

16 (76%)

-

Preop THA patients

39

NR

27 (69%)

-

Postop TKA or THA patients

48

NR

36 (75%)

NR

Lützner et al. [42]

Patients awaiting TKA randomly assigned to receive coated hypoallergenic implant

61

65.6 (± 9.1)

33 (54%)

CoCrMo with multilayer coating system (Cr, CrN-CrCN, ZrN)

Patients awaiting TKA randomly assigned to receive standard implant

59

68.1 (± 8.2)

34 (59%)

CoCrMo

Sasseville et al. [33]

Postop TKA patients with complications

39

63.3 (± 9.7)

16 (41%)

13 patients—Stainless steel

13 patients—Missing data

5 patients—Ti

2 patients—CoCr, Ti

1 patient – OxZr

1 patient – OxZr, Ti

1 patient—CoCr

1 patient—Ceramic

1 patient—Stainless steel × 2

1 patient—Stainless steel and OxZr

Tam et al. [34]

Pre-op patients referred for evaluation of MHS before implantation of orthopaedic (n = 21), cardiovascular (n = 7), dental (n = 8) and other (n = 4) devices

(12 TKA patients)

40

48.7 (11–90)

32 (80%)

NR

Postop patients referred for evaluation of MHS after implantation of orthopaedic (n = 49), cardiovascular (n = 4), dental (n = 28) and other (n = 6) devices

(27 TKA patients)

87

58.3 (14–85)

62 (71%)

NR

Thomas et al. [35]

TKA patients with yet unexplained complications (loosening, recurrent effusions, and pain)

25

63.0 (37–75)

9 (36%)

CoCrMo

"OA-control group" – OA patients awaiting TKA

12

69.2 (52–89)

11 (92%)

-

"PT-control group" – patients without implant but having undergone patch testing for suspected skin allergy

8

64.3 (53–75)

6 (75%)

-

Thomas et al. [36]

TKA (n = 189) and THA (n = 61) patients suspected of having allergic reactions with complaints of pain (90.5%), reduced ROM (74%), swelling (67.5%), effusions (29%), loosening (16.5%) and eczema (5.5%)

250

64.8 (37–84)

164 (66%)

CoCrMo

Thomas et al. [37]

Patients with eczema without metal implant, no CMI

30

52.4 (18–75)

8 (27%)

-

Patients with eczema without metal implant, with CMI

38

61.6 (44–75)

34 (89%)

-

Postop TKA (n = 43) and THA (n = 53) patients without symptoms/complications

100

72.4 (29–96)

75 (75%)

CoCrMo

Postop TKA (n = 187) and THA (n = 13) patients with symptoms/complications

200

64.4 (37–84)

130 (65%)

CoCrMo

Treudler and Simon [38]

Postop TKA patients with suspicion of contact allergy to implant material

13

62.8 (42–94)

9 (69%)

11 patients—CoCrMo

2 patients—Ti

Verma et al. [39]

Postop TKA patients with eczema surrounding the knee

15

65 (65–80)

13 (87%)

Femur: CoCrMo

Tibia: TiAlV

Webley et al. [40]

Control group – patients with rheumatoid arthritis or osteoarthritis without prostheses

33

64 (47–76)

26 (79%)

-

Postop patients with hinge arthroplasty of the knee investigated for possible metal sensitivity

50

66 (44–76)

38 (76%)

Walldius or Guepar type hinge arthroplasty

Zeng et al. [41]

Patients undergoing TKA and monitored for post-operative pain

29

65.1 (± 9.2)

25 (86%)

25 patients – Gemini MKII PS

4 patients – NR

Patients undergoing THA and monitored for postoperative pain

67

48.3 (± 14.9)

32 (48%)

-