Removal of orthopaedic implants: indications, outcome and economic implications

The removal of implants after fracture healing has always been a topical and controversial issue. Undisputed however, is the removal of implants which are associated with complications. In this paper, we evaluated the indications, the outcome and economic cost to the patient and the health system of routine removal of implants after union.

This is a two-year comparative, prospective study carried out in three hospitals in North Central Nigeria. All patients who presented for implant removal and consented to the study were recruited. Fracture union was confirmed both clinically and radiological. Direct costs of treatment paid for by the patients and number of absences from work and school were used as economic indices.

Forty-seven patients comprising 20(42.6%) males and 27(57,4%) females, mean age of 31.6 (±13.4) years were analysed. Forty-two (89.4%) had fixation with plates and screws, three (6.4%) had screws with cerclage wire and two(4.2%) had tension band wiring. Patient request was the main indication for removal in 34(72.3%), surgeon's request without symptoms in 7(14.9%),six(10.7%) were symptomatic comprising four(8.5%) due to postoperative chronic osteomyelitis and intractable pain in two(4.3%). Total cost of implant removal was $33,293.59 ($ 708.37 ±22.10; range $366.97-1,100.92). Total cost of removal in patients with symptomatic implants-in-situ was $3,678,90( $ 613.15±14.50) One patient had a refracture. Mean duration away from work or school was 16 days.

Routine removal of implants after fracture union constituted great waste of highly needed cash in both direct cost and loss of man-hour especially in a dwindling economy in an era of evidence based Medicare and best practice. It is recommended that each hospital adopts strict criteria for implant removal.