Metalwork removal in potential army recruits. Evidence-based changes to entry criteria

Area of Science:

• Orthopedic Surgery
• Military Medicine

Background:

• Civilian medical practice and existing literature do not advocate for routine removal of metal implants in asymptomatic patients.
• A significant risk of complications is associated with the surgical removal of retained metalwork.

Discussion:

• The Ministry of Defence (MoD) and Army Medical Services should align with current National Health Service guidelines and standards of care.
• The literature consistently indicates that metal implant removal is not clinically indicated unless specific, sound reasons exist.
• While no direct comparison exists for recruits with retained metal, evidence suggests basic military training can be undertaken without undue risk.

Key Insights:

• No supporting studies or papers were found for the current British Army policy on metal implant removal.
• Evidence does not support the routine removal of metalwork in asymptomatic military recruits.
• The British Army is revising its policy regarding retained metalwork in recruits due to a lack of supporting evidence.

Outlook:

• Future policy changes in the British Army will likely reflect current evidence-based guidelines for metal implant management.
• Further research may be needed to establish specific protocols for managing retained metalwork in military personnel.
• The focus will shift towards individualized patient assessment rather than routine removal of implants.