Prospective Study of Indications and Outcomes of Implant Removal in Orthopaedic Surgeries

Background:Fracture fixation has become improved with the advancements and usage of new and custom metal implants for each type of fracture. Once the union has occured, implant may or may not be removed depending on the implant. Implant removal are among the most commonly performed surgical techniques worldwide. Routine removal is suggested by some surgeons and opposed by others. Nevertheless, some patients require removal of the implants because of various implant related problems. The removal of implants after fracture healing has always been a controversial issue and are associated with complications. Aims of this study was to identify the most common causes for implant removal and complications associated with that.Methods:The present study was carried out from November 2018 to October 2020 at Rajarajeshwari medical college and Hospital. During this period 66 patients underwent implant removal. All patients were operated before for the upper and lower limb fractures. Regular follow up was done periodically for 4 months to evaluate x-rays and functional outcome with questionarie which were developed by Department of Trauma and Orthopaedic Surgery, Cologne Merheim Medical Center, Witten/Herdecke University, Cologne, Germany. Helios Medical Center Wuppertal, ZBAF, Center for Biomedical Education and Research, Witten/Herdecke University, Witten, Germany.Results:A total of 60 patients were studied. 38 of them were male and 22 were females. The mean age was 38 years. The reasons for removal of implants were found to lie in following categories: Pain, doctor recommendation, prominent hardware, infected hardware, elective (patient’s insistence), and other reasons (implant failure). Overall, the most frequently removed implants in our series were tibialnail (19.69% of implants removed), forearm plate (16.66%). 60 out of 66 patients that is 90.90 % were responding patients and 16.66 % of the patients who suffered from subsequent complications. After implant removal because of pain or impaired function (77.55 %) of the patient reported decreased pain, (69.23 %) of patients reported improvement in function as well as. Conclusion:The clinical indications for the implant removal are not well defined, and few definitive data exist to guide whether the routine implant removal is appropriate. Symptomatic implant frequently needs removal. We have found that pain and implant prominence (mechanical symptoms) are the most common indications. Infection is the next most common, followed by hardware failure. Removal of the implant is also challenging and frequently troublesome nature of surgical hardware removal and wear of the implant may make its removal difficult