Removing Pins and Other Surgical Implants

Determining the Benefits, Risk, and Alternatives

intramedually rod
This patient had a metal rod (intramedually rod) placed within her broken tibia to realign the bone and hold the tibia fracture in position. Photo © Jonathan Cluett, M.D.

Orthopedic surgeons commonly use implants for a variety of surgical procedures. Whether your orthopedic surgeon is reconstructing a damaged joint, repairing a fractured bone, or altering the alignment of the skeleton, implants can be used for a variety of surgical procedures.

Implanted metal can help broken bones heal in proper alignment. While these implants do not help the bone heal faster, they can help to hold bones in the proper position while healing takes place. Implants may include metal plates and screws, pins, and intramedullary rods inserted into the cavity of a bone.

While the implants are typically designed to remain in the body forever, there are instances when their removal may be considered appropriate and even necessary.

Indications

In most cases, implants can stay in your body without any harm or consequences, and their removal should never be considered a part of "routine" care.

However, there are exceptions. Some doctors will recommend the removal of syndesmotic screws used for high ankle sprains before weight-bearing is resumed. With that being said, most studies have found no difference in outcomes when comparing retained screws or removed one.

Removal may be indicated if there are signs of metal irritation, including pain and pressure at the insertions site. Your doctor would need to determine whether the screws are causing the problem or if there is some other cause.

Another indication for removal is an infection. Because it is often difficult to neutralize an infection on a non-organic substance like metal, ceramic, or plastic, an infection may be long-lasting and only resolved once the implant is removed.

Removing Metal Implants

In some implant recipients, the metal components can cause irritation to the surrounding tissues. This may cause bursitis, tendonitis, or local complications. In these cases, removal of the metal may relieve this irritation. Some of the signs of problematic metal include:

  • Pain directly at the location of the metal implant
  • Rubbing of the metal implant underneath the skin
  • Grinding sensations around the metal implant

It can be very difficult to predict if the removal of metal implants will improve symptoms of discomfort. In people who have pain that is clearly caused by the implant, the chance of pain reduction is relatively high. If the pain is more generalized, the chance of resolution is more difficult to predict.

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 surgery as the weakened bone collapsed into the drilled hole spaces, particularly in weight-bearing bones of the leg or hip.

The removal of an implant should never be taken lightly. As with any orthopedic surgery, there are risks of infection, nerve injury, and a reaction to anesthesia. Moreover, the removal of an implant may weaken the bone or fail to alleviate the pain.

Consultation with an experienced orthopedic surgeon should always be sought to fully determine the benefits, risk, and alternative approaches to implant removal.

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