Badell Jay S, Cottom James M, Verdoni Tyler
Fellowship Trained Foot and Ankle Surgeon, Hancock Orthopedics, Hancock Health, 801 N. State St, Suite 2100, Greenfield, IN, 46140, USA.
Fellowship Trained Foot and Ankle Surgeon, Director, Florida Orthopedic Foot & Ankle Center Fellowship, 5741 Bee Ridge Rd #490, Sarasota, FL, 34233, USA.
J Foot Ankle Surg. 2025 May-Jun;64(3):302-308. doi: 10.1053/j.jfas.2024.12.010. Epub 2025 Jan 5.
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.
手术中的金属过敏常常报告不足且诊断不足。通常，金属过敏的症状与感染症状极为相似，处理方案是移除引起问题的植入物。术前检查中识别金属过敏对于提供最佳的患者护理和治疗结果至关重要。本报告的目的是阐述术前和术后识别金属过敏患者的方法。利用已发表的全膝关节置换术（TKA）算法以及作者的经验，制定了术前和术后金属过敏的考量因素，以帮助足踝外科医生应对处理金属过敏患者这一复杂任务。迄今为止，作者已将此指南应用于全踝关节置换术、踝关节骨折切开复位内固定术以及第一跖趾关节融合术。虽然已有关于全膝关节置换术金属过敏算法的文献发表，但据作者所知，这是首次将此类算法普遍应用于足踝外科手术。迄今为止，作者采用这些方法不仅能指导患者护理，还能帮助预防未来并发症，或在并发症出现时加以处理，取得了良好的效果。通过全面的患者病史、金属过敏的识别、多学科方法以及术前规划，可以实现良好的治疗结果。
