Metalwork Removal In Potential Army Recruits. Evidence-Based Changes To Entry Criteria

Abstract

Civilian practice and the literature do not support the routine removal of metalwork from the asymptomatic patient. A significant risk of complication exists. The MoD and Army Medical Services are expected to conduct themselves in line with current National Health Service guidelines and standards of care. The literature is clear that removal is not indicated unless sound clinical reasons exist. There is no comparable group to that of the recruit with retained metal, but evidence suggests that the rigors of basic training can be accepted without risk to the individual. If a problem arose then removal could be indicated at that time. No studies or papers in support of this policy were found. No evidence was found to support the current British Army policy, which is now being altered.

Surgeons' beliefs and perceptions about removal of orthopaedic implants

“…The findings from this survey indicate that about 60% of all surgeons do not agree in a routine removal policy in asymptomatic subjects, and that the patient's request is the less important reason to remove material. Many surgeons doubt clinically significant adverse effects of indwelling metal like stress shielding or an allergic or even carcinogenic potential [ 19 - 22 ], and acknowledge the burden of implant removal to hospital resources.…”

Outcome analysis following removal of locking plate fixation of the proximal humerus

“…In addition, 35% of the patients experienced partial relief, whereas 20% of the patients reported no relief [ 24 ]. In a retrospective review of 169 patients, Townend et al noted that 27% had a complete pain relief and 69% had marked relief after nail removal [ 25 ]. However, 3.2% of the patients reported worsening pain after hardware removal.…”

The use of an arthroscopic cannula to remove bone screws

“…Smaller incisions and minimal soft tissue damage may allow better postoperative pain modulation [1]. It may also have a role in patients with highly physical occupations where removal of metalwork may be a hindrance [5].…”