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Indications and Complications of Implant Removal from Extremities in Adult Orthopaedic Patients – A Retrospective Study in a Tertiary Care Hospital.
Keywords:
Hardware Removal, Implant Removal, Screw Removal.Abstract
Objectives: To determine the indications and complications of implant removal from extremities in adult Orthopaedic patients in Abbasi Shaheed Hospital Karachi.
Methods: This retrospective Cohort study was conducted in Orthopedics department Abbasi Shaheed Hospital Karachi. The medical records of all adults patients fulfilling the inclusion criteria who were operated for implant removal were reviewed. The review period extended from 21st January 2019 to 9th January 2021. The indications of implant removal, per operative and post operative complications of implant removal were noted in each case.
Results: We reviewed the record of 64 patients. The mean age was 33±13.3 years. Male patients were 47(73.4%) and females were 17(26.5%). The most common indication of implant removal was infection(23%,n=23.4%) and pain(20.3%,n=13).The most common implant removal was locking compression plates in 19 (29.6%) patients followed by 3.5mm dynamic compression plates in 13(20.3%) and interlocking nail in 12(18.7%) patients. Tibia was the most commonly involved(28.1%,n=18) bone. Per operative complications were difficulty to access the implant in 8(12.5 %) cases, screw breakage in 5(7.8%) patients and implant breakage in 3(4.6%) patients. Post operatively 16(25%) patients were complaining of limb pain while 12(18.7%) patients had persistent local infection.
Conclusion: The most common indication of implant removal was infection in our series. Difficulty to access the implant and screw breakage were the most common per operative complications while pain and persistent local infection were the most common post operative complications.
References
Kadir DM, Ibraheem G, Yakub S, Olawepo K, Babalola OM, Ahmed B, et al. Removal of Orthopaedic Hardware: A 5 year Review. Niger J Orthop Traumas. 2013;12(2):113-118.
Davids JR, Hydorn C, Dillingham C, Hardin JW, Pugh LI. Removal of deep extremity implants in children. J Bone Joint Surg Br. 2010;92(7):1006-1012.
Shrestha R, Shrestha D, Dhoju D, Parajuli N, Bhandari B, Kayastha SR. Epidemiological and outcome analysis of orthopedic implants removal in Kathmandu University Hospital. Kathmandu Univ Med J (KUMJ). 2013;11(2):139-143.
Golbakhsh M, Sadaat M, Noughani F, Mirbolook A, Gholizadeh A, Abedi S. The impact of psychological factors on device removal surgery. Traum Mon. 2016; 21(2):e25871.doi: 10.5812/traumamon.25871.
Abidi SA, Umer MF, Ashraf SM, Mehdi SH, Ahmed SK, Shaikh IA. Outcome of painful implant removal after fracture union. Pak J Surg. 2012;28:114-117.
Zimri F, Mateen M. Broken orthopaedic implant: an experience at PIMS. Ann Pak Inst Med Sci. 2009;5(3):136-140.
Gill UN. Epidemiology of Orthopaedics Fractures in Under-Developed Country Due to Trauma- A Retrospective Study. J Pak Orthop Assoc.. 2016;28(2):64-66.
Amin MQ, Ahmed A, Imran M, Ahmed N, Javed S, Aziz A. Tibial shaft fractures Epidemiology, A 5-year study in Ghurki Trust Teaching Hospital, Pakistan. Professional Med J 2017;24(1):75-81.
Haseeb M, Butt MF, Altaf T, Muzaffar K, Gupta A, Jallu A. Indications of implant removal: A study of 83 cases. Int J Health Sci (Qassim). 2017;11(1):1-7.
Ersen O, Tuzun HY, Ozsezen AM, Bilekli AB, Koca K, Kurklu M. The Procedure with less Interest than it is done in Orthopedic Practice: Implant Removal. Acta Medica Mediterranea. 2019;35(2):825-828.
Trampuz A, Widmer AF. Infections associated with orthopedic implants. Curr Opin Infect Dis.2006;19:349-356.
Busam ML, Esther RJ, Obremskey WT. Hardware removal: Indications and expectations. J Am Acad Orthop Surg. 2006;14:113-120.
Akhtar A, Shami A, Abbassi SH, Zimri F, Mateen MA. Broken orthopaedic implants: An experience at PIMS. Ann Pak Inst Med Sci. 2009;5:136-140.
Peivandi MT, Yusof-Sani MR, Amel-Farzad H. Exploring the reasons for orthopedic implant failure in traumatic fractures of the lower limb. Arch Iran Med. 2013;16:478-482.
Sharma AK, Kumar A, Joshi GR, John JT. Retrospective study of implant failure in orthopaedic surgery. Med J Armed Forces India. 2006;62:70-72.
Bilal M, Gul R.M, Mujahid M, Askar Z. Comparative Performance of Locally Made and the Foreign Made Dynamic Compression Plates. Key Engineering Materials. 2012;510-511.
Mue DD, Yongu WT, Salihu MN, Kortor JN, Elachi IC, Donwa JO. Indications for Removal of Orthopaedic Implants in a Nigerian Tertiary Hospital: A Review of 128 Cases. West Afr J Med. 2021;38(2):166-170.
Schwarz N, Euler S, Schlittler M, Ulbing T, Wilhelm P. Technical complications during removal of locking screws from locking compression plates: a prospective multicenter study. Eur J Trauma Emerg Surg. 2013;39(4): 339-344.
Shah MQ, Zardad MS, Khan A, Ahmed S, Awan AS, Mohammad T. Surgical Site Infection In Orthopaedic Implants And Its Common Bacteria With Their Sensitivities To Antibiotics, In Open Reduction Internal Fixation. J Ayub Med Coll Abbottabad. 2017;29(1):50-53.
Dodenhoff RM, Dainton JN, Hutchins PM. Proximal thigh pain after femoral nailing: Causes and treatment. J Bone Joint Surg Br.1997;79:738-741.
Riedel MD, Cronin PK, Kaiser PB, Kwon JY. A Compatibility Guide for the Orthopaedic Surgeon Planning to Perform Hardware Removal Surgery. J Am Acad Orthop Surg. 2019;27(2):92-95.
Cronin PK, Watkins IT, Riedel M, Kaiser PB, Kwon JY. Implant Removal Matrix for the upper Extremity Orthopedic Surgeon. Arch Bone Jt Surg. 2020;8(1):99-111.
Marise TPC, Yilun H, Andy YKS, David CTC. The ball-less technique: A novel technique for the removal of a broken proximal femoral nail anti-rotation. A technical note. Injury. 2020 ;51(6):1397-1402.
Tantigate D, Riansuwan K, Mahaisavariya B, Sukjaitham K. Breakage of a Lag Screw of Cephalomedullary Nail: A Technique of Removal. Clin Orthop Surg. 2015;7(2):261-263.
Singh SK, Chopra RK, Sehrawat S, Lakra A. A novel method for the removal of distal part of broken intramedullary femoral nail. Acta Orthop Traumatol Turc. 2014;48(2):223-225.
Sonanis SV, Lampard AL, Kamat N, Shaikh MR, Beard DJ. A simple technique to remove a bent femoral intramedullary nail and broken interlocking screw. J Trauma. 2007;63(2):435-438.
Hontzsch D, Stuby FM .Removal of plates and screws. Tips and tricks for problematic cases. Unfallchirurg. 2012r;115(4):291-298.
