Metal Allergy

  • Most common sensitizers are: nickel, cobalt, and chromium
  • Incidence of sensitivity: Chromium=0.2%, nickel=1.3%, and cobalt=1.8% (Swiontkowski MF,  J Orthop Trauma 2001; 15: 86-89).
  • Stainless steel and cobalt-chromium alloys contain the above sensitizers, especially Nickel.
  • Titanium and titanium alloys generally do not contain the above sensitizers.
  • People with a history of allergies to cobalt, chromium or nickel generally are not sensitive to titanium or its common alloys. (Ti-6AL-4V)
  • Metal allergy may affect 10-15% of the population (Hallab N, JBJS 2001;83A:428). Prevalence may be increasing (Thyssen JP, Contact Dermatitis 2007;57:287).


Metal Allergy TKA

  • Patients with metal allergy should be treated with a modular titanium or all poly tibial component and an oxidized zirconium femoral component. Titanium has a propensity for metallosis and is not suitable for the articulating portions of the components. (Laskin RS, CORR 2003;416:191).

Metal Allergy THA

  • Press-fit titanium stem, ceramic (alumina) head, and cementless titanium cup.
  • Titanium femoral heads are susceptibility to abrasive wear. Cemeted titanium stems transmit  greater stresses to the cement column and are not recommended.  Titanium is less stiff than cobalt-chrome (and stainless steel).


  • Hallab N, JBJS 2001;83A:428
  • Thyssen JP, Contact Dermatitis 2007;57:287
  • Barrack RL; OKU: hip and knee reconstruction 3, 2006;345-368