While removing the old material implanted in the body may seem straightforward, it can be one of the most difficult orthopedic procedures. In fact, many orthopedic surgeons describe removing equipment from new trainees and residents as “the most difficult procedure.”
In reality, removing the material is probably not the most difficult surgery – complex spinal surgery, correcting birth defects, reconstructing damaged joints – are all difficult and time-consuming surgeries. However, hardware removal surgery often makes the surgeon and the unsuspecting patient think that the surgery will be quick and easy. While it can be straightforward, hardware removal surgery tends to be much more difficult than you expect.
Why remove material?
In the vast majority of patients with metal in their body, it is not necessary to remove the metal. Metal implants are generally designed to stay in place forever. However, under certain circumstances, the metal must be removed. These include temporary metal devices intended to be in the body for a short time, loose metal, or metal that may need to be removed to allow for further surgery.
The bottom line is that there should always be a good reason for removing metal from the body, as unnecessary removal of material can open the door to possible complications from the surgery.
Complications of hardware removal
- Infection: The most obvious reason for avoiding unnecessary surgery is the possibility of infection. Although infection is rare when removing material (and infection can be a raison to remove the metal), it is certainly possible, and whenever surgery is not absolutely necessary, you should consider whether it is worth it.
- Weakening of the bone: Most metal implants are fixed in the bone. In order to remove the implant from the bone, there is usually a weakening of the bone. Screws removed to leave a hole in the bone, the plates may leave deformation in the bone. Removing these implants can weaken the bone where the implant was used.
- Injury : In order to remove an implant, the tissue and bone surrounding the implant must be moved. This can damage muscles and other tissues in the body. Often bones and soft tissue develop in and around implants, making them more difficult to remove over time.
- Inability to remove the implant: This is the most serious problem and a concern that any orthopedic surgeon who has worked for more than a short time faces. Difficulty in removing an implant can arise if the implant is difficult to locate, if the implant breaks, or in some cases if it is simply stuck. While you can always do more to remove implants, there are times when damage to normal bones and soft tissue is not worth removing the old metal. In these rare circumstances, the effort to remove an implant may be abandoned and the implant, or part of it, left behind.
When material should be removed
There are times when removing hardware can lead to significant benefits. When the implanted metal interferes with normal joint mobility and function, or if metal implants cause soft tissue pain or irritation, their removal may be beneficial.
In some cases, the material is systematically removed to avoid possible problems, and in other cases, the metal is only removed if it begins to cause a problem. There are also times when removing material becomes impossible.
This is often the case when there is a broken metal implant inside the body, which may be normal or expected in some cases after the surrounding bone heals, and not necessarily a problem for the patient.
A word from Verywell
The reality is that most metal implants can be removed, but many don’t have to be. There is always a possibility that what appears to be a simple, straightforward surgical procedure will become much more complicated. For this reason, patients should be wary of hardware removal surgery and ensure that it is necessary and worthwhile.