When performing an orthopaedic device implantation, it should be routine practice for the surgeon to ask the patient if he or she has a metal allergy, and more specifically a nickel allergy. Ask the patient about costume jewelry or button reactions. If it is an elective surgery, obtain a confirmatory test with the aid of a dermatologist or allergist. It is recommended to use a non-nickel implant if the surgery is urgent, the patient has a confirmed allergy, or the patient does not want to undergo testing, as these implants are readily available in 2015. Finally, if the patient has a painful joint arthroplasty and all other causes have been ruled out, order a metal allergy test to aid in diagnosis.