title: Metal allergy screening prior to joint arthroplasty and its influence on implant choice: a delphi consensus study amongst orthopaedic arthroplasty surgeons.
abstract: OBJECTIVE
  This study was undertaken to obtain a consensus amongst joint arthroplasty experts with regards to metal allergy screening prior to joint arthroplasty and the choice of implant in patients with potential metal allergy.
  
  
  METHODS
  A web based Delphi consensus study was used including orthopaedic surgeons that had previously published on the topic of knee, hip or shoulder arthroplasty. Two rounds of questionnaires were sent via electronic mail. Consensus was considered reached if agreement was 60% or higher.
  
  
  RESULTS
  Eighteen surgeons responded to the first and 17 to the second round of questionnaires. There was consensus that patients having metal arthroplasty surgery should not be routinely questioned about metal allergy prior to surgery. There was consensus that patch testing is not necessary even if metal allergy is suspected. Most respondents agreed in proceeding with cobalt chromium or stainless steel implant in patients suspected of metal allergy regardless of the results of cutaneous patch testing.
  
  
  CONCLUSIONS
  This consensus study suggests that routine metal allergy screening prior to joint arthroplasty is not essential. The use of traditional cobalt chromium/stainless steel implants is recommended regardless of the patient's metal allergy status based on expert opinion through this study.
authors.affiliation: Department of Orthopaedic Surgery, Blackpool Victoria Hospital, Lancashire, UK.
authors.forename: Arif
authors.initials: A
authors.lastname: Razak
authors.affiliation: Department of Orthopaedic Surgery, Blackpool Victoria Hospital, Lancashire, UK.
authors.forename: Ananthan Dave
authors.initials: AD
authors.lastname: Ebinesan
authors.affiliation: Department of Orthopaedic Surgery, Blackpool Victoria Hospital, Lancashire, UK.
authors.forename: Charalambos Panayiotou
authors.initials: CP
authors.lastname: Charalambous
keywords: Arthroplasty; Delphi study; Metal allergy