However, the benefits of relative indications such as intended improvement of function, foreign body or pain sensation, spatial limitation for future surgical procedures or plainly the patient’s desire for hardware removal have not yet sufficiently been proven. Certainly, the indication for hardware removal is unquestioned in patients with surgical site infection, metal allergy, soft tissue compromise or failure of the osteosynthesis. There is an ongoing debate concerning the justification of elective surgical implant removal. In 2010, a total of 180,000 hardware removal surgeries were performed in Germany, making it the fourth most common surgical procedure in orthopedic surgery after surgical fracture fixation, arthroscopies and intervertebral disc interventions. Surgical removal of hardware for internal fixation of fractured bones is one of the most frequently performed orthopedic surgeries in the western world. These findings may influence the surgeons’ attitude towards implant removal and their day-to-day routine in patient counseling.
In summary, despite the challenging and frequently troublesome nature of surgical hardware removal our data contradicts the widely held view that implant removal is often without a positive effect on the patients. 96 % of all responding patients and 66 % of the patients who suffered from subsequent complications would opt for surgical implant removal again. Importantly, after implant removal because of pain or impaired function patients reported an improvement in function (72 %) as well as decreased pain (96 %). Patient reported complication rate of implant removal was 10 %. The most frequent indication was a doctor’s recommendation (68 %), followed by pain (31 %) and impaired function (31 %). In 332 patients surveyed, most hardware removals were performed at the ankle joint (21 %) followed by the wrist (15 %). Exclusively, data obtained out of the survey were analyzed. We surveyed patients of a German level one trauma center, who underwent hardware removal in 20, with regard to their personal experiences on implant removal. The purpose of our study was to evaluate the patients’ point of view on implant removal. Current literature offers little data concerning postoperative patient satisfaction. Hardware removals are among the most commonly performed surgical procedures worldwide.
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