No allergic reaction after TKA in a chrome-cobalt-nickel-sensitive patient: case report and review of the literature.

Hypersensitivity to metallic implants remains relatively unpredictable and poorly understood. Although 20-25 % of total joint arthroplasty patients develop metal sensitivity, only a few highly susceptible persons (<1 %) exhibit symptoms. We present a case report of a fifty-two-year-old woman with a preoperatively documented metal allergy who underwent bilateral total knee arthroplasty using a titanium-niobium-coated implant on one side and a chrome-cobalt implant on the other side because of a logistics problem. At 2-year follow-up, no clinical symptoms of allergy or loosening of the implant were observed. Level of evidence IV.

Tactile roughness discrimination of the finger pad relies primarily on vibration sensitive afferents not necessarily located in the hand.

This study aims to investigate the relative contribution of remote mechanoreceptors to perception of roughness and spatial acuity. We examined two unilateral pathological conditions affecting differently innervation of the index finger: unilateral carpal tunnel syndrome (n=12) and surgically repaired complete traumatic median nerve section at the wrist following surgical repair (n=4). We employed a control condition consisting of ring-block anesthesia of the entire index in 10 healthy subjects to model pathological denervation of the fingertip. Spatial acuity and the ability to discern roughness were assessed using a grating orientation task and a roughness discrimination task, respectively. In patients with carpal tunnel syndrome, we observed a significant reduction of spatial resolution acuity but an intact ability to discriminate roughness with the fingertip. For patients with traumatic median nerve section there was no recovery with the grating orientation task up to 20 months post surgery but a progressive and full recovery with the roughness discrimination task between 6 and 9 months. Finally, in the anesthetic ring bloc group, the nerve block completely disrupted performances in grating orientation task, but unexpectedly left unaffected performances in the roughness discrimination task. Taken together, these lines of evidence support the view that the neural mechanisms underlying tactile roughness discrimination differ from those involved in spatial resolution acuity. Vibrotaction is necessary and sufficient for the perception of fine textures and, when the innervation of the fingerpad is compromised, information about textures can be captured and encoded by remote mechanoreceptors located in more proximal tissues where the innervation is intact.