ABSTRACT
CASE: A 38-year-old man underwent bilateral total knee arthroplasty (TKA) and subsequently developed diffuse pain, swelling, and an eczematous rash that spread throughout his body. Despite various pharmacological regimens, sympathetic blocks, aggressive physical therapy, and further knee revisions, the patient's symptoms progressed over a period of 2 years. An in vitro memory lymphocyte immuno-stimulation assay test demonstrated reactivity to nickel after which bilateral revision TKAs with oxidized zirconium alloys resulted in symptomatic improvement. CONCLUSION: Metal hypersensitivity should be considered after the exclusion of infection; however, the concurrent development of complex regional pain syndrome may mask the clinical presentation.