Determining the Benefits, Risk, and Alternatives
Implants can be used for a variety of surgical procedures. An orthopedic surgeon may use implants to reconstruct a damaged joint, repair a bone fracture, or change your body’s skeletal alignment. Ms35649
Intramedullary rods , pins, and other implants do not help bones to heal faster. They do help to hold things in place while the body heals, and they are typically meant to stay in the body forever. There are cases, though, when removing metal plates and screws, or other implants, may be necessary.
This article looks at the reasons for why it may be appropriate to remove these implants. It describes some symptoms that may point toward doing so, as well as possible benefits and risks of implant removal.
In most cases, implants can stay in your body without any harm. Their removal should never be considered a part of “routine” care. However, there are exceptions. They tend to emerge in a specific context, such as ankle surgery, or because of pain, irritation, or infection.
Some healthcare providers will recommend the removal of syndesmotic screws used for high ankle sprains. They intend for this to be done before a person is allowed to bear weight on the affected ankle. That said, most studies have found no difference in outcomes when they compare people whose screws were taken out and those with screws that remained in place.
Infection is a medical indication for implant removal. It is often hard to treat an infection that is in or on a non-organic surface. That’s the case with materials like metal, ceramic, or plastic. For this reason, removing the implant may offer the best chance to resolve an infection.
Some people experience pain or pressure at the site where an implant was inserted. This may be one of the signs of metal irritation, and it too can lead to having implants removed. Your healthcare provider would need to confirm if the screws are causing the problem or if there is another cause.
The metal elements in some implant products can cause irritation to the nearby tissues. This may lead to bursitis, an inflammation within the joint, or tendonitis and other complications at the site of the implant. Removal of the metal may be what’s needed to treat the irritation.
While these don’t always mean that there’s a problem, some signs of metal irritation are:
It can be quite hard to predict if the removal of metal implants will improve symptoms. In people who have pain that is clearly caused by the implant, the chance of reducing the pain is relatively high. If the pain is more generalized, it may be more difficult to tell if removal will work.
There are reasons for why you and your healthcare provider might consider removing an implant. Screws, rods, or other implants used during orthopedic surgery can cause infection. People who have implants also may report pain and irritation at the site where the implants were placed. It’s possible, and may even be necessary, to have another surgery to remove them. But it doesn’t always work, and your surgeon can help you to decide if implant removal is the best option.
The actual process of removing an implant is itself complex. This is especially true of deep implants that have been in place for a long time. Fractures have been known to occur soon after surgical removal. This is because the weakened bone collapses into the drilled hole spaces used for the implant. This is a notable concern in leg or hip bones that have to bear body weight.
Any implant removal should never be taken lightly. There are surgical risks that may include:
The removal of an implant may weaken the bone. It also may not work to reduce any pain. Be sure to talk with an experienced orthopedic surgeon so that you fully understand the benefits and risks, as well as any treatment alternatives that may be available.
The ability to help people to heal from orthopedic injuries by using various medical implants has offered many benefits. Sometimes, though, people report pain and irritation at the site of the implant. They may feel a grinding in their joint or irritation where the implant rubs below the skin.
In these cases, it may be better to remove implants even though they were meant to stay in place. Removal itself requires more surgery and comes with its own risks, including infection. It’s also an option that doesn’t always work. Your healthcare provider will need to assess whether an implant removal is likely to succeed.
If you have pins, screws, or other surgical implants, it’s likely that you and your healthcare team hoped for success. That’s what happens in most cases, but not always. If you’re discouraged by the results, talk to your orthopedic surgeon about your options. It may be possible or even necessary to have the implant removed.
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Kellish AS, Shahi A, Rodriguez JA Jr, et al. Implant removal due to infection after open reduction and internal fixation: trends and predictors. Arch Bone Jt Surg. 2022;10(6):514-524. doi:10.22038/ABJS.2021.53838.2688
Goodman SB, Gallo J, Gibon E, Takagi M. Diagnosis and management of implant debris-associated inflammation. Expert Rev Med Devices. 2020;17(1):41-56. doi:10.1080/17434440.2020.1702024
Kellam PJ, Harrast J, Weinberg M, Martin DF, Davidson NP, Saltzman CL. Complications of hardware removal. J Bone Joint Surg Am. 2021;103(22):2089-2095. doi:10.2106/JBJS.20.02231
By Jonathan Cluett, MD Jonathan Cluett, MD, is board-certified in orthopedic surgery. He served as assistant team physician to Chivas USA (Major League Soccer) and the United States men's and women's national soccer teams.
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