Should metal hypersensitivity skin-patch testing be included in the usual preoperative total joint arthroplasty work-up?

I do not include metal sensitivity testing in the preoperative evaluation of patients undergoing total joint arthroplasty. Given the increased use of ceramic heads, most total hips implanted in the U.S. today are nickel-free. The issue is more about total and unicompartmental knees, most of which have a cobalt-chromium-nickel alloy femoral component.