Orthopaedic Implant Removal

Epidemiology and Outcome Analysis

Authors

  • Chikwendu Nwosu Federal Medical Centre, Birnin Kebbi, Kebbi State Author
  • Taofeek Olanrewaju Adeyemi Federal Medical Centre, Birnin Kebbi, Kebbi State Author
  • Oni Nasiru Salawu Federal Medical Centre, Birnin Kebbi, Kebbi State Author
  • Joseph Olorunsogo Mejabi Federal Medical Centre, Birnin Kebbi, Kebbi State Author
  • Abidemi Abiola Fadimu Federal Medical Centre, Birnin Kebbi, Kebbi State Author

Keywords:

Orthopaedic implant, outcome, removal

Abstract

Background: Implant removal represents one of the most common operations in bone and joint surgery. After fracture union, the implant loses its purpose and continues to exist only as a foreign object inside the patient’s body and the question arises whether the implant should be removed, and if so, why and when. While early implant removal increases the risk of re‑fracture, delayed removal may result in more difficult and extensive operating procedures, due to a stronger bony integration and overgrowth on implants. This will provide essential information needed for hospital policy formulation. Aims and Objectives: The aim of this study is to determine the prevalence, indications and outcomes following orthopaedic implant removal and to proffer appropriate solutions. This will provide essential information needed for hospital policy formulation. Patients and Methods: This is a retrospective study of all cases of implant removal performed in the Orthopedic Unit of Federal Medical Center and Surgery Department of Sir Yahaya Memorial Hospital all in Birnin Kebbi, Kebbi State, North‑western Nigeria from January 2011 to December 2017. Case notes of the patients were retrieved and relevant information was extracted and analysed. Results: A total of 113 implants were removed from 111 patients. There were 78 males and 33 females, with a male to female ratio of 2.4:1. The peak age group is the 36–45 years. The longest duration of implant was from 13 to 18 months. Plate and screws constituted 76 (67%) of all implants removed. The femur was involved in 49 (43.3%) cases. Patient’s request constituted 46 (41.5%) of the indications. There was retained hardware in 6 (5.4%) cases while external fixation (17, 15.3%) was the most common additional procedure performed. Conclusion: Most of the implants stayed for more than a year. Plate and screws were the most common implants removed. The femur was the most involved bone. Patient’s request was the most common indication for removal. Retained hardware was the most common post‑operative complication while external fixation was mostly performed as an additional procedure.

Author Biographies

  • Chikwendu Nwosu, Federal Medical Centre, Birnin Kebbi, Kebbi State

    Department of Surgery, Federal Medical Centre, Birnin Kebbi, Kebbi State, Nigeria

  • Taofeek Olanrewaju Adeyemi, Federal Medical Centre, Birnin Kebbi, Kebbi State

    Department of Surgery, Federal Medical Centre, Birnin Kebbi, Kebbi State, Nigeria

  • Oni Nasiru Salawu, Federal Medical Centre, Birnin Kebbi, Kebbi State

    Department of Surgery, Federal Medical Centre, Birnin Kebbi, Kebbi State, Nigeria

  • Joseph Olorunsogo Mejabi, Federal Medical Centre, Birnin Kebbi, Kebbi State

    Department of Surgery, Federal Medical Centre, Birnin Kebbi, Kebbi State, Nigeria

  • Abidemi Abiola Fadimu, Federal Medical Centre, Birnin Kebbi, Kebbi State

    Department of Surgery, Federal Medical Centre, Birnin Kebbi, Kebbi State, Nigeria

References

1. Sidky A, Buckley RE. Hardware removal after tibial fracture has healed.Can J Surg 2008;51:263‑8.

2. Zbigniew G, Ronald WL. Removal versus retention of orthopedictrauma implants. Orthop Knowl Online J 2015;13:2.

3. Vos DI, Verhofstad MH. Indications for implant removal afterfracture healing: A review of the literature. Eur J Trauma Emerg Surg2013;39:327‑37.

4. Onche II, Osagie OE, INuhu S. Removal of orthopaedic implants:Indications, outcome and economic implications. J West Afr Coll Surg2011;1:101‑12.

5. Haseeb M, Butt MF, Altaf T, Muzaffar K, Gupta A, Jallu A, et al. Indications of implant removal: A study of 83 cases. Int J HealthSci (Qassim) 2017;11:1‑7.

6. Marintschev I, Rausch S, Fujak A, Klos K, Hofmann GO, Gras F, et al. Removal of a femoral nail with osseous overgrowth at the end‑cap:A navigated and cannulated minimally invasive technique. ComputAided Surg 2013;18:41‑6.

7. Kuubiere CB, Mogre V, Alhassan A. Incidence and indications fororthopedic implant removal: A retrospective analysis. J Life Sci Res2015;2:76‑86.

8. Kadir BM, Ibraheem GH, Yakub S, Onuchukwu NS, Olawepo K, Babalola OM, et al. Removal of orthopedic hardware: A five yearreview. Niger J Orthop Trauma 2013;12:113‑8.

9. Busam ML, Robert RJ, Obremsky WT. Hardware removal: Indicationsand outcome. J Am Acad Orthop Surg 2006;14:113‑20.

10. Varunjikar MD, Joshi SC, Varunjikar AM, Joshi CR. Implant removal:An unsolved challenge to the orthopedician. J Evol Med Dent Sci2014;3:4282‑6.

11. Jung HG, Kim JI, Park JY, Park JT, Eom JS, Lee DO, et al. Is hardwareremoval recommended after ankle fracture repair? Biomed Res Int2016;2016:5250672.

12. Shrestha R, Shrestha D, Dhoju D, Parajuli N, Bhandari B, Kayastha SR,et al. Epidemiological and outcome analysis of orthopedic implantsremoval in Kathmandu university hospital. Kathmandu Univ MedJ (KUMJ) 2013;11:139‑43.

13. Bachoura A, Yoshida R, Lattermann C, Kamineni S. Late removalof titanium hardware from the elbow is problematic. ISRN Orthop2012;2012:256239.

14. Hanson B, van der Werken C, Stengel D. Surgeons’ beliefsand perceptions about removal of orthopaedic implants. BMC Musculoskelet Disord 2008;9:73.

15. Twaddle B. Implant removal. AO Trauma Operating Room PersonnelHandbook. Davos Switzerland: AO Publishers; 2013. p. 1‑15.

16. Reith G, Schmitz‑Greven V, Hensel KO, Schneider MM,Tinschmann T, Bouillon B, et al. Metal implant removal: Benefits anddrawbacks – A patient survey. BMC Surg 2015;15:96.

17. Mue DD, Yongu WT, Elachi IC, Salihu MN. Surgeons’ perceptionabout removal of orthopedic implants. IOSR J Dent Med Sci2014;13:8‑13.

18. Hak DJ, McElvany M. Removal of broken hardware. J Am Acad OrthopSurg 2008;16:113‑20.

19. Ogundele OJ, Ifesanya AO, Adesanya AA, Alonge TO. Removal oforthopaedic implants from patients at the university college hospital,Ibadan. Afr J Med Med Sci 2013;42:151‑5.

Downloads

Published

2018-06-30

How to Cite

Nwosu, C., Adeyemi, T. O., Salawu, O. N., Mejabi, J. O., & Fadimu, A. A. (2018). Orthopaedic Implant Removal: Epidemiology and Outcome Analysis. Nigerian Journal of Orthopaedics and Trauma, 17(1), 12-16. https://njot.org/njot/article/view/3