Pathophysiology
Metal hypersensitivity is an underreported complication post-TAA, presenting with various symptoms including dermal reactions [PMID:37088977].
Clinical Presentation
A patient developed a diffuse rash 7 weeks postoperatively, along with potential pain, swelling, and erythema, leading to a diagnosis of metal allergy [PMID:32840132].
Diagnosis
Identification of metal allergies in the preoperative workup is imperative to differentiate symptoms from infection [PMID:39765305].
Diagnosis of metal hypersensitivity requires ruling out other causes; diagnostic tests include skin patch testing, LMIT, and LTT [PMID:37088977].
Allergy testing revealed positive reactions only on the articulating sides of the implant, highlighting the necessity of testing both sides for accurate diagnosis [PMID:32840132].
Management
Good outcomes can be achieved with a multidisciplinary approach, thorough patient history, and pre-operative planning to address metal allergies [PMID:39765305].
Utilizing specific guidelines for metal allergy identification has helped prevent future complications in procedures such as total ankle arthroplasty and first metatarsophalangeal joint arthrodesis [PMID:39765305].
Initial management often involves nonoperative approaches like topical dermatological care; severe cases may necessitate explantation followed by revision with hypoallergenic implants or conversion to ankle fusion [PMID:37088977].
Due to persistent complications from metal allergy, the patient required conversion to arthrodesis as a management strategy [PMID:32840132].
References
1 Badell JS, Cottom JM, Verdoni T. Approach to patients with metal allergies in foot and ankle surgery. The Journal of foot and ankle surgery : official publication of the American College of Foot and Ankle Surgeons 2025. link 2 Anastasio AT, Balu AR, Johnson L, Crook B, Parekh SG. Metal Hypersensitivity Following Total Ankle Arthroplasty: Case Series and Literature Review. Foot & ankle specialist 2025. link 3 Gaston TE, Kwan S, Skibicki HE, Cheesman QT, Daniel JN. Morbidity After Metal Allergy to a Total Ankle Implant. Foot & ankle specialist 2020. link