F M Kovar1, E Strasser2, M Jaindl3, G Endler4, G Oberleitner3. 1. Department of Trauma Surgery, General Hospital Vienna, Medical University Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria. Electronic address: florian.kovar@meduniwien.ac.at. 2. Department for Neurosurgery, University Hospital St. Poelten, Probst Fuehrer-Srasse 4, 3100 St. Poelten, Austria. 3. Department of Trauma Surgery, General Hospital Vienna, Medical University Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria. 4. Muehl-Speiser Laboratories GmbH, Praterstrasse 22, 1020 Vienna, Austria.
Abstract
BACKGROUND: 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? HYPOTHESIS: 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. RESULTS: 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 1.5 years, compared to 79.17% in the NMIR group after 2 to 3.5 years (NS). In the MIR group 1 refracture occurred, compared to 4 in the NMIR group (NS). CONCLUSION: 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.
BACKGROUND: 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? HYPOTHESIS: 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. RESULTS: 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 1.5 years, compared to 79.17% in the NMIR group after 2 to 3.5 years (NS). In the MIR group 1 refracture occurred, compared to 4 in the NMIR group (NS). CONCLUSION: 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.
Authors: Alexandre Boulos; Steven F DeFroda; Justin E Kleiner; Nathan Thomas; Joseph A Gil; Aristides I Cruz Journal: J Clin Orthop Trauma Date: 2017-07-01
Authors: Anderson Freitas; Landwehrle de Lucena da Silva; Renilton Rodrigues Costa; Lucas Sacramento Ramos; Marcos Norberto Giordano; Henrique Mansur Gonçalves Journal: Rev Bras Ortop (Sao Paulo) Date: 2021-03-31