Indications for implant removal: a prospective study
DOI:
https://doi.org/10.18203/issn.2455-4510.IntJResOrthop20190440Keywords:
Implants removal, Failure of implantsAbstract
Background: The implants removal after fracture healing has always been an issue of controversy. After union, the implant ceases to be important and can be removed. Nevertheless, some patients require metallic implant removal due to various implant-related difficulties. Our study was aimed to identify the most common causes for removal of implant.
Methods: The patients admitted for implant removal in our department were consented and included in the study. Pre-operative radiological images collected and evaluated. Post-operatively, images were taken and followed for resolution of symptoms or appearance of new problems.
Results: A total of 60 patients were studied. Of these, 47 were males and 13 were females. Mean age was 33.7 years (range 4-70 years). Patient request (35% of patients) was the main indication for removal of implants. Reasons were found to be discomfort due to implant, infection, failure of implants and others.
Conclusions: Belief regarding hardware removal has been set and most of them are agreed that routine removal should not be performed unless obviously indicated. In our attempt to fill this gap, we trust that routine removal should not be performed in ‘asymptomatic’ patients. The procedure should not need a big procedure than the implant fixation surgery. Procedure should be sought also as a risk like refracture, bleeding, infection, neurovascular injury and prior to surgery, proper consent to be taken and patient should be well explained. Sometimes indicated results expected after surgery can’t be fulfilled, and instead, complication can results.
References
Hanson B, van der Werken C, Stengel D. Surgeons’ beliefs and perceptions about removal of orthopaedic implants. BMC Musculoskelet Disord. 2008;9:73.
Busam ML, Esther RJ, Obremskey WT. Hardware removal:indications and expectations. J Am Acad Orthop Surg. 2006;14(2):113–20.
Loder RT, Feinberg JR. Orthopaedic implants in children:survey results regarding routine removal by the pediatric and nonpediatric specialists. J Pediatr Orthop. 2006;26(4):510–9.
Bo¨stman O, Pihlajama¨ki H. Routine implant removal after fracture surgery: a potentially reducible consumer of hospital resources in trauma units. J Trauma. 1996;41(5):846–9.
Mølster A, Behring J, Gjerdet NR, Ekeland A. Removal of osteosynthetic implants. Tidsskr Nor Laegeforen. 2002;122(23):2274–6.
Jamil W, Allami M, Choudhury MZ, Mann C, Bagga T, Roberts A. Do orthopaedic surgeons need a policy on the removal of metalwork? A descriptive national survey of practicing surgeons in the United Kingdom. Injury. 2008;39(3):362–7.
Vos DI, Verhofstad MH. Indications for implant removal following fracture healing:A review of literature. Eur J Trauma Emerg Surg. 2013;39:327-37.
Schmittenbecher PP. Implant removal in children. Eur J Trauma Emerg Surg. 2013;39:345-52.
Matthew LB, Robert JE, William TO. Hardware Removal: Indications and Expectations. J Am Acad Orthop Surg. 2006;14(2):113-20.
Sanderson PL, Ryan W, Turner PG. Complications of metalwork removal. Injury. 1992;23(1):29–30.
Richards RH, Palmer JD, Clarke NM. Observations on removal of metal implants. Injury. 1992;23(1):25–8.
Mu¨ller-Fa¨rber J. Metal removal after osteosyntheses. Indications and risks. Orthopade. 2003;32(11):1039–57.
Georgiadis GM. Percutaneous removal of buried antegrade femoral nails. J Orthop Trauma. 2008;22(1):52–5.
Hidaka S, Gustilo RB. Refracture of bones of the forearm after plate removal. J Bone Joint Surg Am. 1984;66(8):1241–3.
Deluca PA, Lindsey RW, Ruwe PA. Refracture of bones of the forearm after the removal of compression plates. J Bone Joint Surg Am. 1988;70(9):1372–6.
Rumball K, Finnegan M. Refractures after forearm plate removal. J Orthop Trauma. 1990;4(2):124–9.
Langkamer VG, Ackroyd CE. Removal of forearm plates. a review of the complications. J Bone Joint Surg Br. 1990;72(4):601–4.
Rosson JW, Shearer JR. Refracture after the removal of plates from the forearm. An avoidable complication. J Bone Joint Surg Br. 1991;73(3):415–7.
Chia J, Soh CR, Wong HP, Low YP. Complications following metal removal:a follow-up of surgically treated forearm fractures. Singapore Med J. 1996;37(3):268–9.
Abidi SA, Umer MF, Ashraf SM, Mehdi SH, Ahmed SK, Shaikh IA. Outcome of painful implant removal after fracture union. Pak J Surg. 2012;28:114-7.
Shrestha R, Shrestha D, Dhoju D, Parajuli N, Bhandari B, Kayastha SR. Epidemiological and outcome analysis of orthopedic implants removal in Kathmandu University Hospital. Kathmandu Univ Med J. 2013;11:139-43.
Haseeb M, Butt MF, Altaf T, Muzaffar K, Gupta A, Jallu A. Indications of implant removal: A study of 83 cases. Int J Health Sci (Qassim). 2017;11(1):1–7.
Brown OL, Dirschl DR, Obremskey WT. Incidence of hardware-related pain and its effect on functional outcomes after open reduction and internal fixation of ankle fractures. J Orthop Trauma. 2001;15:271-4.
Minkowitz RB, Bhadsavle S, Walsh M, Egol KA. Removal of painful orthopaedic implants after fracture union. J Bone Joint Surg Am. 2007;89:1906-12.
Akhtar A, Shami A, Abbassi SH, Zimri F, Mateen MA. Broken orthopaedic implants:An exerience at PIMS. Ann Pak Inst Med Sci. 2009;5:136-40.
Peivandi MT, Yusof-Sani MR, Amel-Farzad H. Exploring the reasons for orthopedic implant failure in traumatic fractures of the lower limb. Arch Iran Med. 2013;16:478-82.
Sharma AK, Kumar A, Joshi GR, John JT. Retrospective study of implant failure in orthopaedic surgery. Med J Armed Forces India. 2006;62:70-2.
Khan MS, Rehman S, Ali MA, Sultan B, Sultan S. Infection in Orthopedic Implant Surgery, Its Risk Factors and Outcome. J Ayub Med Coll Abbottabad. 2008;20(1):23-5.
Beaupré GS. Csongradi JJ. Refracture Risk after Plate Removal in the Forearm. Journal of Orthop Trauma. 1996;10(2):87-92.
