Hardware Removal: Indications and Expectations
Matthew L. Busam, MD, Robert J.
Esther, MD, MSc and William T. Obremskey, MD, MPH
Reprint requests: Dr. Obremskey, Division of Orthopaedic
Trauma, Vanderbilt University, Medical Center East, South Tower,
Suite 4200, Nashville, TN 37232-8774.
Although hardware removal is commonly done, it should not be
considered a routine procedure. The decision to remove hardware
has significant economic implications, including the costs of the
procedure as well as possible work time lost for postoperative
recovery. The clinical indications for implant removal are not well
established. There are few definitive data to guide whether implant
removal is appropriate. Implant removal may be challenging and lead
to complications, such as neurovascular injury, refracture, or
recurrence of deformity. When implants are removed for pain relief
alone, the results are unpredictable and depend on both the implant
type and its anatomic location. Current literature does not support
the routine removal of implants to protect against allergy,
carcinogenesis, or metal detection. Surgeons and patients should be
aware of appropriate indications and have realistic expectations of
the risks and benefits of implant removal.
J Am Acad Orthop Surg, Vol 14, No 2, February
2006, 113-120.
© 2006 the American Academy of Orthopaedic Surgeons
My Broken Hip Hardware Removal Experience - August 1, 2008
Ever since my very serious fracture on December 15, 2005 I
have experienced pain. After the bone healed the pain was centered in my
soft tissues. I had muscle pain and finally bursitis that did not respond
to any form of exercise, physical therapy or steroid injections. In
addition, my iliotibial band (IT band - a ligament that runs from the top of the
hip to below the knee to hold the leg together), was quite painful for a long
time. The surgeon and I finally agreed that surgical removal of the lag
screw in my hip, a bursectomy and an IT band release was the only course of
action left. I have had few good nights sleep in the past 2.5 years
because of the ongoing discomfort.
The image to the left is the pre-surgical x-ray showing
how the lag screw protrudes from the side of my femur. It is about 4 and
3/4 inches long and about 7/16ths of an inch in diameter. That is what has been
causing the ongoing pain. The long pin that runs the length of my femur is
called a gamma nail and is about 17" long.
The picture below is the actual lag screw that was taken out
with the palm of my hand and a dime for scale.
If you look really closely at the head of the gamma nail in the top photo you
can see the faint impressions of threads. That is actually a set screw that
locked the lag screw into place. That was a good thing because it helped to
keep my leg from shortening during the healing. Current designs do not
include the set screw.
I did not include the images of the incision that stared below the pin and
traveled up to the top of my hip. He had to open up the top of the gamma nail
and chisel out the bone to release the set screw. That took considerably more
chiseling than the screw. Yes, I could hear it all but rejected the offer of
more sedation. The good news was that the sedation made time fly and I had no
sensation of the fact that it actually took over 2 hours to get the job done.
Intermediate update
I was on crutches for about two weeks post-op and in
significant pain for two months. Both soft tissue and the bone pain added
up but after a couple of months the bone pain was the greater factor. I
started exercising after four weeks.
My Broken Hip Hardware Removal - 4 month
update
January 1, 2009 marks four months since the screw was removed
from my broken hip. The bone pain from the removal and the replacement
graft was significant for a couple of months and has slowly tapered off so by
this date I finally feel much better than I did before the surgery. I have
been exercising twice a week at the gym since the end of the first month post-op
and have been gradually able to add leg exercises and increase intensity.
The orthopedic doctor indicated that the bone pain could last six months and
that full healing could take a year.
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Vital resources for managing your healthcare
and recovering from a broken hip
