Complications of Hardware Removal

Area of Science:

• Orthopaedic Surgery
• Patient Safety
• Medical Device Removal

Background:

• Orthopaedic hardware removal is a frequent procedure aimed at improving patient function.
• Despite its commonality, the complication profile of hardware removal procedures has received limited research attention.
• Understanding these risks is crucial for informed patient and surgeon decision-making.

Purpose of the Study:

• To analyze the complication rates associated with isolated hardware removal procedures.
• To identify the types and frequencies of complications following hardware removal.
• To inform clinical practice and patient counseling regarding the risks of hardware removal.

Main Methods:

• Utilized the American Board of Orthopaedic Surgery (ABOS) de-identified database (2013-2019).
• Included Current Procedural Terminology (CPT) codes for implant removal (20680, 20670, 22850, 22852, 22855, 26320).
• Focused analysis on hardware removal procedures performed without concurrent procedures ('HR-only').

Main Results:

• 13,089 HR-only procedures were identified, comprising 2.1% of all surgeries analyzed.
• An overall complication rate of 9.6% was observed for HR-only procedures.
• Common complications included wound healing issues (2.1%), infection (1.6%), and unexpected reoperations (2.5%). Serious events like nerve injury (0.6%) and life-threatening complications (0.4%) also occurred.

Conclusions:

• Hardware removal procedures are associated with a significant overall complication rate of 9.6%.
• While severe complications are rare, common issues like wound problems and reoperations necessitate awareness.
• Surgeons and patients must acknowledge the inherent risks involved in orthopaedic hardware removal.