Observations on removal of metal implants.

A total of 86 adult patients who underwent routine surgery to remove metal internal fixation devices were studied prospectively. At the time of surgery, 46 patients were symptomatic, but only 27 requested surgery; 59 were admitted for routine surgery on medical advice. There was no correlation between symptoms, the length of time the implant had been in situ or the location of the implant. Good results were achieved in 91 per cent of symptomatic patients and no problems occurred in 95 per cent of asymptomatic cases. Overall there was a 3 per cent complication rate including one refracture, one radial nerve injury and one haematoma. No wound infections occurred. Potential difficulties in the removal of implants and possible risks of retained implants are discussed, relating to refracture, osteopenia, metal toxicity and neoplasia. In conclusion, it may be appropriate to leave asymptomatic implants in situ, except for femoral and tibial diaphyseal plates.