Ethical dilemmas still need to be evidence based
Daniel Sokol has given an interesting account on what surgeons should do when encountered with surgical time-critical dilemmas.
His dilemma on nickel allergy in knee replacement is however founded on no clinical evidence. There is no doubt that skin allergy to nickel may occur in certain individuals, however there is no evidence either clinically or via known biological mechanisms that links nickel allergy with joint replacement failure (1).
The ‘metal allergy’ debate has led to an industry in expensive nickel-free implants, but this is based on no biological evidence.
In my opinion, the ethical debate in this case is how to discuss the risks, benefits and expectations from surgery, when the patient is convinced that the presence of nickel may lead to a poor outcome. Should the surgeon use a more expensive, unfamiliar implant for such cases? I think not.
1. Middleton S, Toms A. Allergy in total knee arthroplasty. A review of the facts. Bone Joint J 2016; 98-B(4):437-41.
Competing interests: No competing interests