Approach to patients with metal allergies in foot and ankle surgery

Metal allergies in surgery are often underreported and under diagnosed. Oftentimes, the symptoms of metal allergy closely resemble those of infection and the protocol is removal of the offending implant. Identification of metal allergies in the preoperative workup is imperative to provide the best patient care and outcomes. The purpose of this report is to present considerations to approach to both preoperative and postoperative identification of patients with metal allergies. Utilizing published algorithms for total knee arthroplasty (TKA) and the author's experience, considerations for both preoperative and postoperative metal allergy have been developed to help the foot and ankle surgeon with the complicated task of addressing patients with metal allergies. To date, the authors have utilized this guidelines for total ankle arthroplasty, ankle fracture open reduction internal fixation, and first metatarsophalangeal joint arthrodesis. While literature has been published with metal allergy algorithms for total knee arthroplasty, this is the first of its kind for adaptation to foot and ankle surgery in general to the author's knowledge. To date, the authors have favorable outcomes utilizing these approaches to not only guide patient care but to help prevent future complications or address them if they present. With a thorough patient history, identification of metal allergies, a multidisciplinary approach and pre-operative planning, good outcomes can be achieved.