Metal hypersensitivity in joint arthroplasty is a very controversial topic with limited evidence. With increasing numbers of joint replacements being done annually, a clear understanding of the pathogenesis, clinical picture, preimplant screening, postimplant workup, and treatment plan is crucial. This review article looked at all the available evidence regarding metal hypersensitivity and summarized the key findings. An algorithm was also proposed for preimplant screening, postimplant workup, and management.