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Outcomes of Hardware Removal Surgery for Children
Insights
Deep hardware removal in children is a common orthopedic procedure. This study found that hardware removal in pediatric patients is safe and effective, with excellent outcomes and minimal complications.
Area of Science:
- Orthopedic Surgery
- Pediatric Orthopedics
- Surgical Outcomes
Background:
- Hardware removal is a frequent orthopedic procedure in the United States.
- Deep hardware removal in pediatric patients requires specific outcome evaluation.
- Previous literature on deep hardware removal outcomes in children is limited.
Purpose of the Study:
- To evaluate the outcomes of deep hardware removal in patients younger than 18 years.
- To identify factors influencing complication rates in pediatric hardware removal.
- To establish the safety and efficacy of deep hardware removal in children.
Main Methods:
- Retrospective review of 227 deep hardware removal procedures in patients under 18 years old.
- Data collected from 2007 to 2017, including patient demographics, surgical details, and complications.
- Analysis of hardware locations, indications for removal, and surgeon experience level.
Main Results:
- A total of 227 procedures were analyzed with a mean follow-up of 25 months.
- The most common hardware locations were femur (85), humerus (49), and tibia (46).
- Only 3 complications were reported, with outcomes described as excellent.
Conclusions:
- Deep hardware removal in children is a safe and effective procedure.
- Excellent outcomes can be achieved with a low complication rate.
- Involving senior residents as primary surgeons may minimize complications in teaching hospital settings.
Abstract:
Hardware removal is among the most common orthopedic procedures performed in the United States. The goal of this study was to report the outcomes of deep hardware removal for children. This study received institutional review board approval. Patients younger than 18 years who underwent deep hardware removal between 2007 and 2017 were studied. We reviewed 227 procedures involving 132 boys and 95 girls. Mean follow-up was 25 months (range, 14-36 months). Mean age at the time of surgery was 12.8 years (range, 2-17 years). Mean time from initial surgery to hardware removal was 8.4 months (range, 1-72 months). Of the 227 cases, 75 used a tourniquet. Mean tourniquet time was 30.1 minutes (range, 1-118 minutes). Mean length of surgery was 44.0 minutes (range, 4-173 minutes). Mean resident level performing the surgery was postgraduate year 3 (range, postgraduate year 2 to fellow). There were 3 complications. Locations of the implanted hardware included: femur, 85; humerus, 49; tibia, 46; hip/pelvis, 17; ulna, 11; miscellaneous foot, 10; radius, 6; and fibula, 3. Indications for surgery included surgeon recommendations in 122 cases; symptomatic hardware in 68 cases, and parent wishes in 37 cases. Hardware removal for children was safe, and the outcomes were excellent. Complications of hardware removal at a teaching hospital can be minimized when a more senior resident is the primary surgeon. Despite the challenging and historically troublesome nature of deep hardware removal, the current study shows that hardware removal for children is safe and effective. [Orthopedics. 2022;45(2):e91-e95.].
