Orthopedic Implant Removal in the Department of Orthopedics of a Tertiary Care Centre of Nepal: A Descriptive Cross-sectional Study

Bhandari, Ravi; Dawadi, Pravakar; Magar, Mohit Thapa; Sinha, Ritesh; Kayastha, Nirab; Shah, Rajesh Pratap; Thapa, Bikash Bikram; Magar, Sushil Rana

doi:10.31729/jnma.6171

Cited by 3 publications

(1 citation statement)

References 6 publications

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“…A descriptive cross-sectional study done at a tertiary care center found that implant removal surgery formed nearly one-fifth of the total orthopedic operations; implant removal was done as an elective procedure in 80% cases. More than 50% of patients undergoing implant removal were in the age group of 17 to 39 years [ 11 ].…”

Section: Discussionmentioning

confidence: 99%

An Unusual Complication Encountered During the Extraction of the Femoral Nail: A Case Report

Dhaniwala,

Saoji,

Dhaniwala

et al. 2024

Cureus

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Orthopedic implant removal is a common surgery performed either due to patient’s complaint of pain, dysfunction or infection or on doctor’s advice depending on the nature of the implant and its related future problems. The surgery may range from simple k-wire removal to difficult plate or intramedullary nail removal. Many unforeseen complications are experienced during implant removal, and occasionally, it results in failure of removal, fracture, prolonged per-operative bleeding and damage to nerves and vessels. We report here an unusual complication of coiling of a thick k-wire used during implant extraction surgery to prevent sinking of the nail and the difficulties in removing this coil and the nail, along with the precautions to be taken to avoid such difficulties.

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Section: Discussionmentioning

confidence: 99%

An Unusual Complication Encountered During the Extraction of the Femoral Nail: A Case Report

Dhaniwala,

Saoji,

Dhaniwala

et al. 2024

Cureus

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If we should remove internal fixation devices for rib fractures?

Jiang

Zhao

et al. 2023

J Cardiothorac Surg

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Background Internal fixation for rib fractures has been widely carried out worldwide, and its surgical efficacy has been recognized. However, there is still controversy about whether implant materials need to be removed. At present, the research on this topic is still lacking at home and abroad. Therefore, in this study, the patients undergoing removal of internal fixation for rib fractures in our department within one year were followed up, to statistically analyze implant-related complications, postoperative complications and postoperative remission rate. Methods A retrospective analysis was conducted on 143 patients undergoing removal of internal fixation for rib fractures from 2020 to 2021 in our center. The implant-related complications, postoperative complications and postoperative remission rate of patients with internal fixation were analyzed. Results In this study, a total of 143 patients underwent removal of internal fixation, among which 73 suffered from preoperative implant-related complications (foreign-body sensation, pain, wound numbness, sense of tightness, screw slippage, chest tightness, implant rejection), and 70 had no post operative discomfort but asked for removal of internal fixation. The average interval between rib fixation and removal was 17 ± 9.00 (months), and the average number of removed materials was 5.29 ± 2.42. Postoperative complications included wound infection (n = 1) and pulmonary embolism (n = 1). of the 73 patients with preoperative implant-related complications, the mean postoperative remission rate was 82%. Among the 70 patients without preoperative discomfort, the proportion of discomforts after removal was 10%. No perioperative death occurred. Conclusion For patients with internal fixation for rib fractures, removal of internal fixation can be considered in the case of implant-related complications after surgery. The corresponding symptoms can be relieved after removal. The removal presents low complication rate, and high safety and reliability. For patients without obvious symptoms, it is safe to retain the internal fixation in the body. For the asymptomatic patients who ask for removal of internal fixation, the possible risk of complications should be fully informed before removal.

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Burden of routine orthopedic implant removal a single center retrospective study

AlOmran,

Alosaimi,

Alshaikhi

et al. 2024

World J Orthop

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BACKGROUND Open reduction and internal fixation represent prevalent orthopedic procedures, sparking ongoing discourse over whether to retain or remove asymptomatic implants. Achieving consensus on this matter is paramount for orthopedic surgeons. This study aims to quantify the impact of routine implant removal on patients and healthcare facilities. A retrospective analysis of implant removal cases from 2016 to 2022 at King Fahad Hospital of the University (KFHU) was conducted and subjected to statistical scrutiny. Among these cases, 44% necessitated hospitalization exceeding one day, while 56% required only a single day. Adults exhibited a 55% need for extended hospital stays, contrasting with 22.8% among the pediatric cohort. The complication rate was 6%, with all patients experiencing at least one complication. Notably, 34.1% required sick leave and 4.8% exceeded 14 d. General anesthesia was predominant (88%). Routine implant removal introduces unwarranted complications, particularly in adults, potentially prolonging hospitalization. This procedure strains hospital resources, tying up the operating room that could otherwise accommodate critical surgeries. Clearly defined institutional guidelines are imperative to regulate this practice. AIM To measure the burden of routine implant removal on the patients and hospital. METHODS This is a retrospective analysis study of 167 routine implant removal cases treated at KFHU, a tertiary hospital in Saudi Arabia. Data were collected in the orthopedic department at KFHU from February 2016 to August 2022, which includes routine asymptomatic implant removal cases across all age categories. Nonroutine indications such as infection, pain, implant failure, malunion, nonunion, restricted range of motion, and prominent hardware were excluded. Patients who had external fixators removed or joints replaced were also excluded. RESULTS Between February 2016 and August 2022, 360 implants were retrieved; however, only 167 of those who met the inclusion criteria were included in this study. The remaining implants were rejected due to exclusion criteria. Among the cases, 44% required more than one day in the hospital, whereas 56% required only one day. 55% of adults required more than one day of hospitalization, while 22.8% of pediatric patients required more than one day of inpatient care. The complication rate was 6%, with each patient experiencing at least one complication. Sick leave was required in 34.1% of cases, with 4.8% requiring more than 14 d. The most common type of anesthesia used in the surgeries was general anesthesia (88%), and the mean (SD) surgery duration was 77.1 (54.7) min. CONCLUSION Routine implant removal causes unnecessary complications, prolongs hospital stays, depletes resources and monopolizing operating rooms that could serve more critical procedures.

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Orthopedic Implant Removal in the Department of Orthopedics of a Tertiary Care Centre of Nepal: A Descriptive Cross-sectional Study

Cited by 3 publications

References 6 publications

An Unusual Complication Encountered During the Extraction of the Femoral Nail: A Case Report

An Unusual Complication Encountered During the Extraction of the Femoral Nail: A Case Report

If we should remove internal fixation devices for rib fractures?

Burden of routine orthopedic implant removal a single center retrospective study

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