The Metal in My Body: Patients' Perception and Attitude Toward Orthopedic Implants

Metal implants are broadly used in orthopedics and traumatology to stabilize bone fragments. This study aimed to explore patients' awareness, body image, and overall experience of living with a metal implant after a fracture.

A mixed methods convergent design (QUAN+QUAL) was adopted. A self-reported 30-item questionnaire was used to investigate patients' perception and apprehension of the implantation of orthopedic materials. To enlighten the quantitative findings, semi-structured interviews followed till data saturation. Quantitative and qualitative data were compared during the analysis phase.

Results showed that women's and elders' acceptance of the implants was greater than that of men and younger patients even in acute cases. The sense of superiority provided by the implant was mainly reported by the elderly (adjusted odds ratio (OR_adj) for increasing age: 1.06; 95% CI: 1.02-1.1; p<0.01), and the sense of inferiority was mainly reported by young men (OR_adj: 6.19; 95% CI: 2.36-16.22; p<0.01). Similarly, women and elderly mostly tended to answer that the injured limb felt stronger after the implant placement, while young men tended to answer a sense of weakness with the implant (OR_adj for increasing age: 1.06; 95% CI: 1.03-1.09; OR_adj for male gender: 4.67; 95% CI: 1.87-11.7; p<0.01 for both regressions). Most participants (56.6%) and mainly young participants, regardless of gender, expressed the desire to get the metal implants removed (OR_adj for increasing age: 0.91; 95% CI: 0.89-0.95; p<0.01). Misinformation and misconception were also found in a high percentage of the questioned patients (48.1%). Thematic analysis of the interviews revealed that none of the participants directly attributed any change in their life, self, or body image to the implants. An altered body image was not reported. The most reported experience was the restriction of movement due to the accident or the subsequent physical weakness.

Despite the acceptance of the implant being great, the level of patient knowledge was fairly low. The present study highlights the importance of providing patients with information throughout their management to avoid misunderstandings. Age and gender did influence patients' perception of the implants. Personalized assessment is further needed to address body image issues after an implant placement procedure.