Implant Removal Complications in Pediatric Orthopedics

Implant removal is a common practice in pediatric orthopedics, despite its risks. The present study aims to evaluate postoperative complications following implant removal in pediatric patients, correlating them with epidemiological factors.

Retrospective cross-sectional study, conducted in a tertiary hospital, with analysis of medical records and imaging exams from February 2021 to June 2024. Medical records of patients under 18-years-old who were followed up until outpatient discharge were evaluated. The research included age, sex, type of implant, indication for insertion and removal, time to implant removal, and postoperative complications, which were classified according to Clavien-Dindo.

A total of 202 medical records were analyzed. Implant removal was more common in boys, with a mean age of 12 years, and the mean time to removal was 16 months. The main reason for placement was orthopedic trauma, and for removal, bone consolidation. The complication rate was 10% (n = 22). Plate removal had the highest complication rate (15%), followed by isolated screws (14%), external fixators (12%), flexible nails (10%), and Kirschner wires (8%). The main complications were unsuccessful removal (45.5%), superficial infection (36.5%), refractures (9%), and movement limitation (9%). The Clavien-Dindo classification revealed 45.45% type I complications, 40.9% type II complications, and 13.6% type IIIa complications.

Implant removal in pediatric orthopedics is not without complications, with 11% being found in this study. Failure to completely remove the implant, superficial infections, and refractures were the most common. Before the procedure, the risks and benefits involved should be considered and consensus should be reached among family members and surgeons.