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Hardware Removal: Indications and Expectations

Dr. Busam is Resident, Department of Orthopaedics and Rehabilitation, Vanderbilt University, Nashville, TN. Dr. Esther is Resident, Department of Orthopaedics, University of North Carolina, Chapel Hill, NC. Dr. Obremskey is Assistant Professor, Department of Orthopaedics and Rehabilitation, Division of Orthopaedic Trauma, Vanderbilt University.

None of the following authors or the departments with which they are affiliated has received anything of value from or owns stock in a commercial company or institution related directly or indirectly to the subject of this article: Dr. Busam, Dr. Esther, and Dr. Obremskey.

Reprint requests: Dr. Obremskey, Division of Orthopaedic Trauma, Vanderbilt University, Medical Center East, South Tower, Suite 4200, Nashville, TN 37232-8774.

Although hardware removal is commonly done, it should not be considered a routine procedure. The decision to remove hardware has significant economic implications, including the costs of the procedure as well as possible work time lost for postoperative recovery. The clinical indications for implant removal are not well established. There are few definitive data to guide whether implant removal is appropriate. Implant removal may be challenging and lead to complications, such as neurovascular injury, refracture, or recurrence of deformity. When implants are removed for pain relief alone, the results are unpredictable and depend on both the implant type and its anatomic location. Current literature does not support the routine removal of implants to protect against allergy, carcinogenesis, or metal detection. Surgeons and patients should be aware of appropriate indications and have realistic expectations of the risks and benefits of implant removal.

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