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[Practical guidelines for difficult and complex hardware removal in orthopedic surgery]
Martin C Jordan1, Justus Bremer2, Abdul Al Refai2
1Klinik für Orthopädie, Unfallchirurgie und Rehabilitative Medizin, Universitätsmedizin Greifswald, Fleischmann Straße 8, 17475, Greifswald, Deutschland. martin.jordan@med.uni-greifswald.de.
Objective:
Safe and complete removal of osteosynthesis materials while preserving the surrounding soft tissues.
Indications:
Indications include implant-related pain, soft-tissue irritation, infection, implant failure, pseudarthrosis, and risk to adjacent tendons, nerves, or vessels as well as implants in children.
Contraindications:
Disproportionate procedural risk in patients with poor bone quality, extensive scarring, or high surgical morbidity.
Surgical Technique:
Thorough preoperative planning, precise identification of the implant type and manufacturer, and the availability of the manufacturer's original extraction tools as well as alternative extraction instruments-such as special extractors, carbide drills, and hollow reamers-are essential. In this article, stepwise removal techniques are detailed for screws, plates, intramedullary nails, and spinal or pelvic implants, including strategies for managing stripped, cold-welded, or fractured implants.
Postoperative Management:
Early functional rehabilitation is encouraged. Following removal of load-bearing implants, temporary activity restrictions and postoperative X‑rays to detect iatrogenic fractures are recommended.
Clinical Relevance:
Implant removal is a frequent yet technically demanding procedure. Careful preparation, appropriate instrumentation, and meticulous technique reduce complications and enhance patient safety.
