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MEDICAL COMMENTARY
CONTRIBUTING AUTHORS
■ JEREMIE M. AXE,
MD is a Fellow at the Harvard Shoulder
and Elbow Service in Boston, Mass. He plans
to return to Delaware
in Autumn 2015 and practice with First State Orthopaedics in Newark, Del.
■ NATHAN J. SINZ, BA is a research assistant on the Harvard Shoulder and Elbow Service in Boston, Mass.
■ MICHAEL J. AXE, MD is a senior partner at First State Orthopaedics.
are two series that are recommended
prosthesis series”18 or the “Mayo prosthesisseries.”19 Somesurgeons12 forego additional testing if a metal allergy is suspected and place a non- nickel implant. If a patient develops
a cutaneous manifestation or implant failure, not due to the setting of an infection or mechanical failure, it is recommended that the patch test be performed to help identify the cause.12 metal allergy in the setting of a joint replacement is case dependent and may include retention of the implant or removal with replacement of a non-nickel implant.
SUMMARY
When performing an orthopaedic device implantation, it should be routine practice forthesurgeontoaskthepatientifhe
or she has a metal allergy, and more patient about costume jewelry or button reactions. If it is an elective surgery,
aid of a dermatologist or allergist. It is recommended to use a non-nickel implant if the surgery is urgent, the patient has a want to undergo testing, as these implants are readily available in 2015. Finally, if the patient has a painful joint arthroplasty and all other causes have been ruled out, order a metal allergy test to aid in diagnosis.
The Medical Society of Delaware does not endorse any brands of medication or
discretion of the authors.
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Singer A. Beauty: a little known allergy. The New York Times Magazine. Available at: http://www.nytimes.com/1985/12/15/magazine/beauty- a-little-known-allergy.html Accessed August 4, 2014.
Granchi D, Cenni E, Guinti A et al. Metal hypersensitivity testing in patients undergoing joint replacement: a systematic review. J Bone Joint Surg Br. 2012;94:1126-1134.
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