Nickel Allergy And Nickel Free Implants In Joint Replacement Surgery: An Analysis Of Current Practice In Scotland
ABSTRACT Background: Nickel is the most common metal sensitizer in humans with a prevalence of approximately 14%. The effects of nickel allergy on the performance of an orthopaedics implant are unclear and there are no UK guidelines on the use of nickel free implants for joint replacement surgery in patients with a history of nickel allergy. This cohort study looks at the current practice of surgeons in Scotland in their approach to nickel allergy and use of nickel free implants in the patient undergoing major joint replacement surgery. Methods: An anonymous questionnaire was sent to all orthopaedic consultants in the west of Scotland. Results: Eighty-seven questionnaires were sent, with a response rate of 63.2% (55 replies). 54.5% (30) did ask patients if they had a nickel allergy. 86.7% (26) of these would go on to use a nickel free implant when the patient gave a history of allergy. Of the 25 who did not ask about nickel allergy, 72% (18) would use a nickel free implant if they knew that the patient was allergic to nickel. Only 12.7% (7) stated that they did have a unit policy for the use of implants in a nickel allergic patient. Conclusions: This variation in practice is likely to be a reflection of the lack of evidence and guidance on this topic. It suggests that there is a variation in opinion amongst surgeons of the importance of a cutaneous hypersensitivity and its potential effects on the performance of an implant placed deep within the tissues. Further research is needed before evidence based decisions can be made on the use of nickel free implants.