NICKEL ALLERGY: Surgeons Beware

Area of Science:

• Orthopaedic Surgery
• Allergology
• Biomaterials

Background:

• Metal allergies, especially to nickel, can complicate orthopaedic device implantation.
• Patient history of reactions to jewelry or buttons may indicate a predisposition to metal hypersensitivity.

Purpose of the Study:

• To establish best practices for identifying and managing patients with potential metal allergies undergoing orthopaedic procedures.
• To provide guidance on implant selection and diagnostic testing for metal hypersensitivity in orthopaedic patients.

Main Methods:

• Pre-operative screening for metal allergy history, including specific questioning about nickel sensitivity.
• Recommendations for confirmatory allergy testing in elective cases, involving dermatologists or allergists.
• Guidelines for implant selection based on surgical urgency, confirmed allergies, or patient preference regarding testing.

Main Results:

• Non-nickel implants are a viable and available option for patients with confirmed allergies or those who decline testing.
• Metal allergy testing can be a valuable diagnostic tool for painful joint arthroplasty when other causes are excluded.

Conclusions:

• Integrating metal allergy screening into routine orthopaedic pre-operative protocols is essential.
• Personalized implant selection and timely allergy testing can mitigate risks and improve patient management in orthopaedic surgery.