In our last post, we provided an overview of how surgical hardware, or implants, are used by podiatric surgeons in order to correct bone fractures and other related issues in the foot and ankle. In most cases, these medical implants are designed to stay in the body indefinitely. Bone and soft tissue will heal around the hardware, eventually restoring normal function and mobility. Many patients will heal and give little thought to the hardware, especially if they don’t see (or feel) any sign of it in their day-to-day activities.
However, there are cases where surgical hardware is used temporarily. In certain types of injuries or surgical procedures, the implant is meant to be temporary in nature. Once the injury has healed, the hardware is considered to have served its purpose, and a plan may be set for its removal.
In other instances, the hardware itself may cause discomfort, pain or stiffness. This can happen with any use of medical implants, but it is especially common in the joints. Most complaints of discomfort come from those who are physically active, particularly those who engage in sports and other demanding activities. There is a reason professional athletes usually opt for hardware removal as soon as they’ve been cleared by their surgeon. While they may be perfectly capable of performing to expectation, these individuals are very in-tune with their bodies and how every movement or exercise “should feel.” If hardware is interfering with their perception of optimal performance, it’s no surprise that they would be willing to return to the O.R. to have it removed.
Is it a good idea to remove surgical hardware?
For a long time, medical hardware was removed as a routine procedure. However, improvements in implant materials, design and surgical techniques – as well as patient outcomes – caused a shift towards leaving hardware in.
However, there are many valid reasons for considering hardware removal.
- Pain – Is your medical implant causing pain or discomfort? This is usually due to the hardware irritating surrounding tissue, including tendons, ligaments, cartilage, muscle and bursae.
- Implant movement or failure – There have been instances where screws “grew” or “poked out” after some period of time. Such a screw should be removed particularly when healing has occurred. At other times, the hardware can be damaged due to stress, or there may be an infection associated with the implant.
- Allergy – Some patients develop an allergy to materials in the implant. While surgeons try to avoid this scenario, it’s not always possible to know if the patient has a sensitivity prior to its use.
- Non-union – This is an incomplete healing of the bone that may be caused by surgical hardware that became too loose (inadequate stabilization), excess gap in bone fragments, or loss of blood supply. Non-union typically requires hardware removal and another surgery to re-initialize the healing process.
Your surgeon should carry out an examination to ascertain that the hardware is the cause of the issue, and that it is safe to remove it. He may order X-rays and/or CT scan imaging prior to scheduling surgery.
When should implants be removed?
Most surgeons will typically recommend that hardware removal take place around 12-18 months following the original implant. The average period of time has been reported as 16.8 months.
Potential Complications with Hardware Removal
The main goal of this surgical procedure is to safely remove hardware without complication or causing damage to nearby soft tissues. The success, however, is dependent on the type of surgery you had, whether the original fracture has healed, which part of the body is involved, the function of the implant and the health status of the patient.
You should bear in mind that a surgery is still a surgery. There are risks associated with every surgical procedure. The most common risks are contracting an infection, and the possibility of further damaging tissues that have been compromised by the first surgery. The surgeon may need to make bigger incisions to remove the hardware. Finally, your life may be disrupted once again. The surgeon may immobilize you, or at least direct that you not bear weight on the affected foot or ankle for several weeks. The body will require rest and time to heal, though usually for less time than the original surgery. For those who must keep weight off their feet for an extended period of time, physical therapy may be recommended.
Once a strange, sci-fi concept, the idea of receiving a medical implant is now commonplace and widely accepted. At Houston Foot and Ankle Care, many surgical procedures involve the use of screws, plates, pins, wire and other devices…as well as their removal. Call us at (713) 541-3199 if you have been told you need surgery requiring an implant, or if you would like to know if you can safely remove such hardware. Dr. Maislos will provide an expert diagnosis that accounts for your goals and activity levels. We accept most major forms of medical insurance.
Call (713) 541-3199 if you experience:
- pain or discomfort from surgical hardware
- stiffness or limited range of motion
- implant failure