Fractures of the proximal femur commonly occur but the majority of orthopaedic surgeons do not consider general hardware removal as a routine necessity. Indications and time interval for hardware removal in this special selected patient group is still controversial. Therefore we performed a retrospective study to address the following questions: 1) Is there a difference between the medically- (infection, mechanical problems, implant failure) and non-medically indicated group (patients demand, meteoro-sensitivity, foreign body sensation) in relation to complications? 2) Is there a correlation regarding time interval between implantation and removal comparing these two groups? 3) Is there a context related refracture rate? 4) Should non-medically indicated implant removal (IR) be performed due to persistent pressure from the patient?
We hypothesized that non-medically indicated implant removals should be avoided due to a significantly higher number of associated complications.
Patients and methods
A total of 371 consecutive patients with 424 hardware removal procedures following a proximal femur fracture, between 08/1992 and 11/2008, have been included. Study population was divided into two groups according to their indication for implant removal: medically indicated group (MIR) consisted of 299 patients (80.59%) and 72 patients (19.41%) were assigned to the non-medically indicated (NMIR) group.
In the NMIR subgroup a total of (n=21) 28% complications occurred compared to 11.46% in the MIR subgroup; (P<0.005), 86.51% of IR in the MIR group were performed within 1.5years, compared to 79.17% in the NMIR group after 2 to 3.5years (NS). In the MIR group 1 refracture occurred, compared to 4 in the NMIR group (NS).
Non-medically indicated implant removal should be avoided due to the higher complication rate of 28%. Surgeons and patients should be aware of the imminent complications and therefore implant removal should only be performed for good medical reasons.
Level of evidence
Level IV. Historical case study.Le texte complet de cet article est disponible en PDF.
Keywords : Implant removal, Hip fracture, Complications