Improvement in Functional Outcomes After Elective Symptomatic Orthopaedic Implant Removal

Williams, Benjamin R.; McCreary, Dylan L.; Parikh, Harsh R.; Albersheim, Melissa; Cunningham, Brian P.

doi:10.5435/jaaosglobal-d-20-00137

Cited by 12 publications

(10 citation statements)

References 42 publications

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“…Williams et al assessed functional outcomes after IR in a study cohort of 85 patients and detected an improvement in function and ROM in 73% of the upper extremity, which is similar but higher than in our study [ 12 ]. Another study that investigated the outcome after IR of superior clavicle plates demonstrated a decrease in pain and an increase in mobilization in their case series [ 7 ].…”

Section: Discussionsupporting

confidence: 73%

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Elective implant removal in the upper extremity: only symptomatic patients benefit

Hambrecht,

Canal,

Klingebiel

et al. 2023

Eur J Orthop Surg Traumatol

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Purpose Elective implant removal (IR) in the upper extremity remains controversial. Implants in the olecranon and clavicle are commonly removed for prominence, unlike in the distal radius. Patient-reported symptomatic cannot be verified, and nonspecific discomfort remains unquantified. In this study, indications and outcomes of IR at the clavicle, olecranon and distal radius were evaluated, with a focus on postoperative patient satisfaction. Materials and methods In this retrospective, single-center cohort study, patients, who received elective IR of the clavicle, olecranon and distal radius were included. Patients were followed up at least six weeks after IR. Outcomes included patient satisfaction, symptom resolution, and complications. Results One hundred and eighty-nine patients were included. Unspecific symptoms of discomfort were the most prevalent indication for IR (48.7%), followed by pain (29.6%) and objective limited range of motion (ROM) (7%). Pain and limited ROM combined was observed in 13.8%. Subjective benefit following IR was described in 54%. Patients with limited ROM (OR 4.7, p < 0.001) or pain (OR 4.1, p < 0.001) were more likely to experience alleviation of complaints. Patients with unspecific symptoms of discomfort, often did not report improvement. Major complications occurred in 2%. Refractures were detected at the clavicle (3.7%) and at the olecranon (2.5%). Minor complication rate was 5%. Conclusion IR is a safe procedure in the upper extremity. Indications based on unspecific symptoms of discomfort have a significant lower rate of patient satisfaction postoperatively. Elective IR should be considered cautiously, if it is driven primarily by unspecific symptoms of discomfort. Patient education is relevant to prevent dissatisfying outcome.

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Section: Discussionsupporting

confidence: 73%

“…Williams et al described in their cohort of 119 patients a complication rate in 10%. Mostly, superficial infections were described [ 12 ]. In our study, three refractures (3.7%) were detected following IR at the clavicle and occurred within the first two weeks following IR.…”

Section: Discussionmentioning

confidence: 99%

Elective implant removal in the upper extremity: only symptomatic patients benefit

Hambrecht,

Canal,

Klingebiel

et al. 2023

Eur J Orthop Surg Traumatol

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“…However, other clinical studies have suggested hardware removal may improve function and reduce pain. 4,8,17,21,22 Cadaveric data has suggested that the removal of hardware consisting of epiphyseal screws placed in the setting of pediatric ankle fractures may decrease interarticular forces within the ankle. 3 Altering these forces may decrease the risk for subsequent joint degeneration or growth disturbances, and it is commonly cited as the rationale for elective hardware removal in pediatric ankle fractures.…”

Section: Introductionmentioning

confidence: 99%

Rates and Factors Associated With Hardware Removal in Physeal Ankle Fractures: Analysis of the Pediatric Health Information System

Pearce

Cazzulino

Swarup

2023

Foot & Ankle Orthopaedics

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Background: Ankle fractures are among the most common physeal fractures in children. When surgical management is warranted, subsequent hardware removal remains controversial. This study was designed to determine rates of hardware removal in patients with physeal ankle fractures and identify risk factors for removal. Procedure data was utilized to compare rates of subsequent ankle procedures in patients with hardware removed and hardware retained. Methods: We conducted a retrospective cohort study utilizing data from the Pediatric Health Information System (PHIS) for the years 2015 through 2021. We longitudinally followed patients treated for distal tibia physeal fractures to determine the rates of hardware removal and subsequent ankle procedures. Patients with open fractures or polytrauma were excluded. We used univariate, multivariate, and descriptive statistics to characterize the rates of hardware removal, identify factors associated with removal, and assess the rates of subsequent procedures. Results: This study included 1008 patients who underwent surgical management of a physeal ankle fracture. The mean age at index surgery was 12.6 years with an SD of 2.2 years, and 60% of patients identified as male. Two hundred forty-two patients (24%) had their hardware removed at an average time of 276 days (range, 21-1435 days) following index surgery. Patients with Salter Harris III (SH-III) or Salter Harris IV (SH-IV) fractures had hardware removed more often than patients with Salter-Harris II (SH-II) fractures (28.9% vs 11.7%, P < .01). Four-year rates of subsequent ankle procedures are similar between patients with hardware removed and hardware retained. Conclusion: The rate of hardware removal in children with physeal ankle fractures is higher than previously reported. Patients of younger age, higher income, and with fractures involving the epiphysis (SH-III and SH-IV) are more likely to undergo hardware removal. Level of Evidence: Level III, retrospective study.

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“…5 Following the removal of symptomatic implants, patients frequently exhibit statistically significant improvement in function. 6,7 Despite the frequency of these procedures, the complication rates following the removal of implants have been reported to range from 3% to 40%, with almost a 10% complication rate in the largest series. 8 The time spent in the operating room is also unpredictable.…”

Section: Introductionmentioning

confidence: 99%

Standardizing Screw Head Orthopaedic Trauma Implants. Is There an Interest? An OTA Member Survey

Cunningham

Higgins

Vallier

et al. 2022

Journal of Orthopaedic Trauma

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Improvement in Functional Outcomes After Elective Symptomatic Orthopaedic Implant Removal

Cited by 12 publications

References 42 publications

Elective implant removal in the upper extremity: only symptomatic patients benefit

Elective implant removal in the upper extremity: only symptomatic patients benefit

Rates and Factors Associated With Hardware Removal in Physeal Ankle Fractures: Analysis of the Pediatric Health Information System

Standardizing Screw Head Orthopaedic Trauma Implants. Is There an Interest? An OTA Member Survey

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