Fracture Risk Following Hardware Removal in Children With Arthrogryposis

Children with arthrogryposis often undergo lower extremity long bone osteotomy for improved biomechanical alignment with subsequent hardware removal. The incidence of fracture and infection is unknown in this population. Therefore, the aim of this study was to identify the incidence of these complications following hardware removal and compare them to a matched cohort of patients with cerebral palsy.

Patients with arthrogryposis aged 0 to 20 years who underwent lower extremity osteotomy with subsequent hardware removal were included. All hardware removal events were recorded and evaluated for postoperative fracture or infection. For comparative analysis, each patient with arthrogryposis was matched 1:1 with a patient with cerebral palsy based on age, osteotomy location, and implant type at the time of the first hardware removal event.

Fifty-three patients with arthrogryposis were included with a total of 73 hardware removal procedures. Postoperative fractures occurred in 9.4% of patients, and infections in 5.3%. When calculated per hardware removal event, the incidence of both fracture and infection was 6.8%. Thirty-seven patients were successfully matched with a cerebral palsy counterpart. There were no differences in infection rates between groups ( P =1.0); however, the arthrogryposis cohort sustained 3 fractures postremoval, while no fractures were observed in the cerebral palsy cohort.

Children with arthrogryposis have a relatively high risk of fracture following hardware removal after lower extremity osteotomy. Caution is advised when removing metallic implants in this population.

Level III-retrospective comparative study.