Dear Dr. Roach: My wife is in dire need of knee replacements (arthritis, and bone on bone) but she is allergic to nickel, which is found to some degree in all metals -- including titanium -- used in replacements. Is there any solution to this problem?

-- R.B.

A: Nickel allergy varies in severity, and a lot of people have it. Not everyone diagnosed with a nickel allergy really has a nickel allergy.

This is true with many allergies: Many people report being allergic to penicillin, but some of those people had adverse reactions, not allergic ones. However, because penicillin allergies can be very serious, even life-threatening in rare occasions, we take them seriously.

Skin testing can be done (by an allergy specialist) prior to joint replacement to see whether the nickel allergy is significant. This is important, because putting a replacement in someone with a serious allergy can result in pain, swelling and failure of the joint. I had a patient with this issue, who needed to have a repeat surgery to take out the replacement and have a new one put in.

If she truly is allergic, there are nickel-free replacement joints available. Most joints are an alloy of several metals, but some of the titanium alloys contain no nickel at all. Her orthopedic surgeon has access to information about nickel content in the various implants available.

* * *

The booklet on herpes and genital warts explains these two common infections in detail. Readers can obtain a copy by writing: Dr. Roach, Book No. 1202, 628 Virginia Dr., Orlando, FL 32803. Enclose a check or money order (no cash) for $4.75 with the recipient's printed name and address. Please allow 4-6 weeks for delivery.

Dr. Keith Roach writes for North America Syndicate. Send letters to 628 Virginia Dr., Orlando, FL 32803 or email ToYourGoodHealth@med.cornell.edu.

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