Indications of implant removal: A study of 83 cases

Introduction: Fracture fixation has become advanced with the advent of new and custom metal implants for each type of bone/fracture. After union though, the implant ceases to be important, and may be removed. Routine removal is advocated by some, and opposed by others. Nevertheless some patients require removal of the hardware because of various implant related problems. Our study was aimed at identifying the most common causes for implant removal. Objective: To investigate the common indications of orthopaedic implant removal surgeries. Methods: Adult patients admitted for implant removal in our department were included in the study. They were operated in the next OT list. They were then followed for an average 4 months for resolutions of symptoms or appearance of new problems. Results: 83 patients were studied. 71 of them were males. The mean age was 38 years. The reasons for removal of implants were found to lie in five categories: pain/discomfort/prominent hardware; infected hardware; implant failure; elective (patient’s insistence); other reasons. Overall, the most frequently removed implants in our series were distal tibial/ankle plates (14.45% of implants removed), femoral intramedullary nails (13.25%), olecranon wires and plates (12.04%), and tibial intramedullary nails and patellar TBWs (9.53% each). Discussion and conclusion: The clinical indications of implant removal are not well established, and few definitive data exist to guide whether routine implant removal is appropriate. Symptomatic hardware frequently needs removal. We found that pain and implant prominence (mechanical symptoms) are the most common indications. Infection is the next most common, followed by hardware failure. Other indications are implant failure, bone resorption due to excessive stress shielding and patient’s will. Removal is however, not an easy surgery, and several factors like bone ingrowth and wear of the implant may make its removal difficult.