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Hardware: Hardware removal

Partial answers to this question are posted with reference to Should the hardware be taken out?, Does Hardware have to come out on schedule? and Does it hurt to remove the hardware?

To summarize there is a good reason to remove hardware and a theoretical reason (which may also be good). The good reason is if the hardware hurts significantly. Removal is almost always successful in relieving that pain. But you do not get that benefit if you have no pain to start with. I would caution you that some people think they have very little pain and imagine that a mild ache and a twinge when the weather changes are normal after a broken leg. If the plate is taken out for some other reason they are surprised at the improvement. A healed broken leg with no damage to the joint should feel normal.

The theoretical reason for removing hardware is more dodgy (IMO). There is experimental evidence that the bone under a plate is weaker (less dense) than normal and some authorities suggest that this will lead to a higher than normal risk of fracture at the end of the plate. In addition the parts of the bone reinforced with a plate are stiffer than the rest of the bone so there is a "stress riser" at either end of the plate. So the theoreticians say that there is an increased risk of fracture if the plate is left in over the rest of your lifetime.

I am personally sceptical about this and find it difficult to weigh against the known risk of refracture following plate removal (2-5% as discussed elsewhere). Accordingly I advise my patients to consider their symptoms and only have the hardware taken out if they think it reasonable to take some small risks and undergo modest discomfort to relieve those symptoms.

You should be aware that this position is my opinion and not necessarily the consensus position of orthopaedic surgeons. I would welcome comments (?from other OS) on this issue to provide some balance.

Myles Clough MD Jan 21 2002

From: Jennifer

I have plates & screws in my right leg (stainless steel). (Tibial plateau fracture) Is it safe to leave this hardware "in" if it is not bothering me. I've had conflicting info with some people saying it is better to take it out and other people saying it is O.K. to leave in. Your thoughts?? I understand if you can not comment.

From: Patrick

I sustained a tibial plateau fracture in October 1998. My orhopod put in 3 screws. It healed normally after 3 months non weight bearing time. However, the pain was nearly constant after that. I couldn't figure out why. If I swam and took Vioxx (not approved by my plan -- either I paid out of pocket or got samples) the pain seemed LESS. Finally, when I stopped swimming in the summer of 2001, the pain was intense. With every step it killed me. Especially in damp, cool weather (a near constant in San Francisco, where I live.) I finally went to see my orhopod and he said that hardware was removed in 50% of the cases. He suggested more PT and then he'd remove the hardware.
He removed it on Jan 23, 2002. I have had an infection that's caused some pain but now the hardware pain (intense, sharp, throbbing, daily) IS GONE. I'm very happy but also disappointed that someone didn't tell me sooner to pursue removal of this hardware. Should I talk to a lawyer?

From: Chris Fannin

I broke my Tibia and Fibia On Jan 31st 2001. I am now fully healed, and rarely get discomfort. I am debaiting between getting the IM rod removed or not. If i am not feeling any pain, or discomfort, is it worth getting it removed? I am 23 Years old, and the doctor says, due to my age, its worth getting it removed now so i wont have a forigh object in my leg the rest of my life. Any advice?


From: Heike

I have a nail and two screws in my tibia. I have been told by my ortho. that it is up to me to have it taken out or not. He seems to think it's not a big deal either way, but my physio insists that I should have it taken out because of complications down the road. I don't have any pain, really, but I want to know what the risks and benefits all are before I can make an informed decision. Please give me advice, if you can. Thanks

From: georgina

At 7 weeks post op for tib/fib. plate & pin surgery, much pain bilateral ankle. Bone pain is gone but the pain on sides of ankle, even with loose cotton socks, is great. I would love to have the hardware removed but wonder if it is better done in a few months time when bone is stronger or sooner since it may be easier to take out. Will be checking these comments.

From: brendan

I broke my femur in a car accident in november. I am walking without a limp now, but my hip muscle still hurts and i can feel it moving back and forth. Does anybody know how long it takes to heal and should i have the titanium rod removed? I am 33 years old and would appreciate any replies.

From: Tracy

I have had 5 surgeries on my right knee since May 2000. I injured it and have had 3 arthroscopies, a lateral release, surgery to clear up an infection with 5 weeks of intravenous antibiotics and now have developed another opening in my surgical scar. It had all cleared up from the last surgery on March 8th, which was a Fulkerson Osteotomy. Now I have an opening that is really, really deep. Going down to the bone actually. There is no sign of infection but is somewhat red and very painful. I have been told by my OS that it is probably a reaction to the screws, with them being in that same spot, only deeper in. It just wont heal and its been 2 weeks. I am 12 weeks post-op and I am wondering what is the amount of time that they will let go by before they will take out the screws? How do they take out the screws? Is is an outpatient procedure? How can I have a reaction like this one and my blood work come back good? Its really gross and really deep and bad. Anyone that has had this problem would you write to me. I see my surgeon on Thursday and want to know what to expect. Thanks.

From: T

I am having a screw removed from my toe, after surgery will it hurt? The first surgery did and it took me two weeks to recover.

From: Lee

I had a plate and seven screws for spiral tib fracture. The hardware was removed 2 years after the break/operation.

From 9 months post-op, I was playing soccer regularly but could not quite run evenly - there was some slight discomfort. Up to just before the removal, it was as good as it had ever been and I was worried that the removal might set me back somewhat.

I had the operation, was walking the day after and within the week, ran a little. It felt much better!

The downside to the removal - not much really. I did get an infection in my ankle thus slowing my recovery and that's about it. I am so much more comfortable without it...!!

From: Janet

5/15/03 Had the hardware out 3 days ago...YAHOO! In my case, the swelling around the plate & eight screws never went away, (at 8 months after the initial 3-bone ankle break) and it was impossible to wear normal shoes or sneakers, as the top would rub at the bottom screw and make me MISERABLE! As for the removal operation: I worried endlessly about being on crutches again and pain, etc, but it's really not so bad and it's a great feeling to be metal-free! I'm 44 and usually a very fast healer so I'm looking forward to spending the rest of my very long life pain free as well!
Yes, post-op for the removal was painful for the first 2 days but today I'm like a new woman!

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