Bone Cement Hypersensitivity: Clinical Presentation,Diagnosis,and the Role of Patch Testing

Abstract

Abstract: Bone cement, most commonly polymethyl methacrylate (PMMA)-based, is widely used in orthopedic and dental procedures. While generally safe, hypersensitivity reactions to bone cement are underrecognized and can mimic infection or mechanical failure, often leading to delays in diagnosis and treatment. Dermatologists play a key role in evaluation, particularly through the use of patch testing. This review summarizes the clinical features, diagnostic considerations, and management of bone cement hypersensitivity based on 17 publications describing 439 patients who underwent patch testing. PMMA demonstrated the highest sensitization rate, followed by benzoyl peroxide, N,N-dimethyl-p-toluidine, and gentamicin sulfate. Diagnosis is complicated by overlapping symptoms, proprietary ingredient formulations, and the lack of standardized testing protocols. While patch testing remains the primary diagnostic method, adjunctive tools such as lymphocyte transformation testing and histological evaluation may offer additional value in select cases. Management includes topical or systemic corticosteroids and antihistamines, with surgical revision considered for refractory cases. Alternative materials, such as noncemented implants or gentamicin-free formulations, may be appropriate for sensitized patients. Increased clinical awareness is essential to improving outcomes.