Julie Zielinski1, Thomas A Lacy2, Jonathan Huw Phillips3. 1. Peds Orthopedic Surgery, T.C. Thompson Children's Hospital, 910 Blackford Street, Chattanooga, TN 37403, USA. Electronic address: platenscrews@yahoo.com. 2. TLC Pediatric/Adolescent Medicine, 11715 Orpington Street, Suite A, Orlando, FL 32817-4600, USA. 3. Orlando Health, 83 W. Columbia Street, 1222 S. Orange Ave, 5th floor, Orlando, FL 32806, USA.
Abstract
STUDY DESIGN: Retrospective case report. OBJECTIVE: To report the first known case of immunological camouflage of a metal spinal implant with carbon coating. SUMMARY OF BACKGROUND DATA: Metal sensitivity is common and is a consideration when choosing orthopedic implants in susceptible individuals. The sensitivity often is to nickel, cobalt, or chromium, and titanium is used as a safe alternative. However, when the allergy is also to titanium, solutions may be much more difficult. This case describes an innovative solution to a complex metal allergy that includes titanium in a child requiring spinal instrumentation for early-onset scoliosis. METHODS: At age 6 years 7 months, the patient underwent an uncomplicated placement of bilateral posterior Vertical Expandable Prosthetic Titanium Ribs (VEPTRs; Synthes, Inc., West Chester, PA). At that time, there were no known metal allergies. At 3 weeks, the right side had become erythematous and had serosanguineous drainage. It briefly improved after each of 2 surgical debridements and a course of intravenous antibiotics, but within 6 weeks of the index procedure, the pain was still worsening. A titanium allergy was suspected and blood was sent for allergy testing. A test confirmed hypersensitivity to titanium, niobium, molybdenum, iron, and aluminum, among others. The remaining rod was removed. An in vivo trial for tolerance to high-grade stainless-steel implants was done. The implant was removed after 2 weeks because of systemic symptoms that occurred. RESULTS: A plasma-spray, carbon-coated VEPTR rod was designed. A rod sample was inserted into the patient's forearm for trial. After 3 months, there was no appreciable reaction. Carbon-coated VEPTRs were placed without complications. The patient has undergone multiple lengthening using the carbon-coated VEPTRs. CONCLUSIONS: In the rare patient with multiple allergies, choosing orthopedic implants can be challenging. An innovative carbon coating was applied by plasma spray to the VEPTR system, with good results.
STUDY DESIGN: Retrospective case report. OBJECTIVE: To report the first known case of immunological camouflage of a metal spinal implant with carbon coating. SUMMARY OF BACKGROUND DATA: Metal sensitivity is common and is a consideration when choosing orthopedic implants in susceptible individuals. The sensitivity often is to nickel, cobalt, or chromium, and titanium is used as a safe alternative. However, when the allergy is also to titanium, solutions may be much more difficult. This case describes an innovative solution to a complex metalallergy that includes titanium in a child requiring spinal instrumentation for early-onset scoliosis. METHODS: At age 6 years 7 months, the patient underwent an uncomplicated placement of bilateral posterior Vertical Expandable Prosthetic Titanium Ribs (VEPTRs; Synthes, Inc., West Chester, PA). At that time, there were no known metalallergies. At 3 weeks, the right side had become erythematous and had serosanguineous drainage. It briefly improved after each of 2 surgical debridements and a course of intravenous antibiotics, but within 6 weeks of the index procedure, the pain was still worsening. A titaniumallergy was suspected and blood was sent for allergy testing. A test confirmed hypersensitivity to titanium, niobium, molybdenum, iron, and aluminum, among others. The remaining rod was removed. An in vivo trial for tolerance to high-grade stainless-steel implants was done. The implant was removed after 2 weeks because of systemic symptoms that occurred. RESULTS: A plasma-spray, carbon-coated VEPTR rod was designed. A rod sample was inserted into the patient's forearm for trial. After 3 months, there was no appreciable reaction. Carbon-coated VEPTRs were placed without complications. The patient has undergone multiple lengthening using the carbon-coated VEPTRs. CONCLUSIONS: In the rare patient with multiple allergies, choosing orthopedic implants can be challenging. An innovative carbon coating was applied by plasma spray to the VEPTR system, with good results.
Authors: Grzegorz Szczęsny; Mateusz Kopec; Denis J Politis; Zbigniew L Kowalewski; Adam Łazarski; Tomasz Szolc Journal: Materials (Basel) Date: 2022-05-18 Impact factor: 3.748
Authors: Harleen Saini; Andy Y Wang; Jacob J Kosarchuk; Furkan Yigitbilek; Laleh Montaser Kouhsari; Knarik Arkun; Ron I Riesenburger; Mina G Safain Journal: Surg Neurol Int Date: 2021-12-30