Metal allergies

@mab1226 I'm sorry you are dealing with this situation. What symptoms led you to be tested? How and by whom was your allergy diagnosed?
How to proceed? First find a doc skilled in revision surgey, then find one familiar with implants safe for you.

Sorry to say, there is no registry of doctors with the skills you need. You need to find a surgeon who specializes in revisions, perhaps begin by calling teaching hospitals in a large city near you and ask who does revisions there. Or search for orthopedic group practices that give a bio for each doctor. When reading the bios, look for keywords like revision or complex cases. A third way is to ask a good physical therapist who they know who does revisions.
Sadly, you are in for some "leg work" to find care, unless the original surgeon has a suggestion.

To the best of my knowledge, I am not allergic to metals. Every surgeon selects, for regular use, a particular robot and implant. Metal allergies aside, I don't think it normally makes much of a difference and one should use a surgeon who is vastly experienced at the procedure.

One of the major companies, Smith & Nephew, makes an implant that is made of oxidized zirconium and it is allegedly biocompatible. The Journey II system. My surgeon uses the Smith & Nephew products all the time for total knee replacements (full disclosure, he is one of the software developers for the CORI robot but he disclosed that to me before the surgery) so I received one of them.

I went to the company's web site and there is a find a specialist link there. You can enter your zip code, enter 50 miles for range, and see which surgery specialists show up. That could be a starting point.

I also asked Google about Kentucky surgeons who do biocompatible replacements. This is its AI answer:

"Kentucky has several highly trained orthopedic surgeons who specialize in complex knee revision surgeries and regularly utilize biocompatible, hypoallergenic options—such as Smith & Nephew’s Oxinium (oxidized zirconium) or pure titanium—for patients with metal sensitivities. Standard knee implants rely on cobalt-chromium, which contains nickel and can cause pain, loosening, or immune reactions in sensitive individuals.
When contacting these providers, explicitly request a consultation regarding hypoallergenic or biocompatible materials (like Oxinium or titanium-coated implants) for a revision procedure.
Orthopedic Revision Surgeons in Kentucky
• Dr. Reid B. Brown, MD: Location: Louisville, KY
Specialty: Complex revision surgery and joint reconstruction. Notably, Dr. Brown is a designated consultant for Smith & Nephew Orthopaedics, the medical technology company that manufactures the Legion Oxinium Knee—one of the industry's leading nickel-free, highly biocompatible implant lines.
• Dr. Stephen Duncan, MD: Location: Lexington, KY
Specialty: Professor and Fellowship Director of Adult Reconstruction at the University of Kentucky. He specializes heavily in complex, repeat, and failed primary joint revisions. He requires patients to provide their original primary operative notes so he can tailor the revision materials to their specific anatomy and biological compatibility needs.
• Dr. Christian P. Christensen, MD: Location: Lexington, KY
Specialty: A national pioneer in joint reconstruction who is actively involved in advanced implant design. He specializes in complex revision surgery for failed or loosened primary implants and is a leading expert on cementless and specialized component technologies.
• Dr. Brian Kern, MD: Location: Paducah, KY
Specialty: Provides highly specialized diagnosis, component analysis, and individualized operative planning for revision knee replacements across Western Kentucky.
• Dr. Tharun Karthikeyan, MD: Location: Lexington, KY
Specialty: Board-certified surgeon specializing in complex and revision adult reconstruction. He has performed over 7,000 replacement surgeries and utilizes state-of-the-art robotic-assisted systems to precisely align custom, non-traditional implant materials.
Biocompatible Implant Options for Revisions
During a revision, your surgeon replaces components from the failing primary implant. If your revision is driven by a suspected metal allergy or localized tissue reaction, the following biocompatible materials are standard solutions:
• Oxidized Zirconium (Oxinium): Transformed into a smooth ceramic surface, this material possesses the strength of metal without any detectable nickel, eliminating the primary driver of metal hypersensitivity.
• Titanium Alloy: Highly bio-friendly and structurally flexible (mimicking natural bone), pure titanium or titanium-polyethylene combinations are used specifically as safe alternatives for patients reactive to cobalt or chromium.
• Hypoallergenic Coatings: Certain revision systems use standard components that are vacuum-layered with protective biocompatible coatings like Zirconium Nitride (ZrN) or Titanium Nitride (TiN) to isolate the underlying metal from body"

I believe that surgeon selection is critical. So I would use this as a starting point but not an end point. Do a lot of research and locate not only a revision surgeon who uses the right materials for you but is a great surgeon as well.

@steveinarizona
Thank you for that excellent summary of your research in answer to @mab1226 .
I had a TKR 4 months ago and have been wondering, albeit belatedly, about metal allergies. For such a serious procedure, one would think they might test for metal sensitivities before surgery, as many folks who don’t wear much jewelry wouldn’t necessarily know if they had a history of reaction.

Revision surgery is a pretty high price to pay for something that could be tested for in advance. After wondering if the governing boards for surgical specialties keep any sort of data on revisions necessitated by metal allergies, I looked it up. Preliminary browser search indicates “Metal allergy accounts for less than 1% of in total knee arthroplasty (TKA) revisions.”

Unfortunately, “there is no single definitive test for implant-related metal allergy.” Many symptoms of a reaction to metals are also caused by other variables. Many times the ONLY way they knew for sure that a patient had a specific metal allergy, is when the person’s symptoms completely disappeared after revision. This difficulty in diagnosing metal allergies is not especially encouraging.

Recalling years-ago instances of inflamed ear lobes after wearing inexpensive earrings, and wondering if metal allergy or some other variable played a part, I’m kind of kicking myself (with my new knee 😂) for not asking my surgeon in advance what type of replacements he uses. I still have quite a bit of swelling, warmth and poor flexion, but my surgeon said it’s not surprising in my particular case, as he had to remove way more tissue than in the usual TKR - several damaged ligaments and tissue necrosis from an old injury. A longer healing curve. Well, time will tell.

Anecdotally, while in an emergency room last year accompanying an ill friend, the man on the next stretcher had come in with extreme pain radiating from his hip replacement, in addition to pain throughout his body. He had been having big problems since immediately after his surgery. The man was scheduled for a revision in just 2 weeks, but his pain had become so unbearable he was seriously worried about internal bleeding. Once he was triaged & got a pain med, he felt talkative and I asked him about what symptoms he’d had after the surgery. They ran the gamut, and I was privately thinking “surgeon error,” or perhaps, gross error or negligence by any member of the surgical team. When I asked him if anyone had mentioned metal allergies as a possible factor in his pain and inflammation issues, he said no, it was never brought up. Maybe there are more people out there with metal sensitivities than they know about, but they’re not testing for it. I’m not suggesting this man had metal allergies; I was just surprised his doctor didn’t ask about it.

Thanks for your considerate browser search, it was truly appreciated.