Removal of deep extremity implants in children

Abstract

We have reviewed our experience of the removal of deep extremity orthopaedic implants in children to establish the nature, rate and risk of complications associated with this procedure. A retrospective review was performed of 801 children who had 1223 implants inserted and subsequently removed over a period of 17 years. Bivariate analysis of possible predictors including clinical factors, complications associated with implant insertion and indications for removal and the complications encountered at removal was performed. A logistical regression model was then constructed using those predictors which were significantly associated with surgical complications from the bivariate analyses. Odds ratios estimated in the logistical regression models were converted to risk ratios. The overall rate of complications after removal of the implant was 12.5% (100 complications in 801 patients), with 48 (6.0%) major and 52 (6.5%) minor. Children with a complication after insertion of the initial implant or with a non-elective indication for removal, a neuromuscular disease associated with a seizure disorder or a neuromuscular disease in those unable to walk, had a significantly greater chance of having a major complication after removal of the implant. Children with all four of these predictors were 14.6 times more likely to have a major complication.

Implantatentfernung nach intramedullären Osteosynthesen

“…Die Komplikationsrate betrug 14%. Mit der erfolgreichen Weiterentwicklung der Markdrahtung mit Titanimplantaten wurden intramedulläre Implantate häufiger auch bei Kindern eingesetzt.Davids et al[9] analysierten in einer retrospektiven Untersuchung 801 Kinder mit 1223 Implantaten über einen Zeitraum von 17 Jahren. Die Gesamtkomplikationsrate nach Implantatentfernung betrug 12,5% (100 Komplikationen in 801 Patienten), davon 48 (6,0%) schwere und 52 (6,5%) leichte Komplikationen.…”

Complications in a Young Adult Attributable to a Retained Pediatric Dynamic Hip Screw

“…Children with a complication following implant insertion were more than three times more likely to have a minor complication following implant removal. This study must be applied to the general pediatric population with caution as 70% of the patients had a neuromuscular disorder [4]. Further recommendations for implant removal were given by Peterson following his own experience combined with a meta-analysis of the current data in 2004.…”

A novel technique for pediatric femoral locked submuscular plate removal: the ‘push-pull’ technique

“…Routine removal in children was justified based on potential future risks, and many institutions offer routine removal of implants to skeletally immature patients [17-19]. Resulting thereof, 60% to 90% of all implant removals in children are performed electively [17,20,21]. Implant removal is not without complications or consequences [14,22-25].…”

“…To our knowledge, no technique for minimally invasive implant removal on long bones has been described. Routine hardware removal is offered most often to pediatric patients [17]. Therefore, we have chosen purposefully a pediatric study population.…”