The case against routine metal removal.

Metal removal is one of the most commonly performed operations in pediatric orthopedics. Many of these operations are performed electively in asymptomatic patients. In a retrospective study of 138 patients who had metal removal operations, the indication for surgery was uncomplicated healing in 69%. The overall complication rate was 13%, including incomplete removal in 7% and refracture in 1.4% after metal removal. Operations to remove metal from the proximal femur were associated with the highest complication rates, especially in patients with slipped capital femoral epiphysis. In a comparison of the risks associated with metal removal operations and the risks of long-term metal retention, little evidence was found to support a policy of routinely removing asymptomatic implants after the completion of bone healing.