The Journal of Bone and Joint Surgery (American). 2007;89:1906-1912.
doi:10.2106/JBJS.F.01536
© 2007 The Journal of Bone and Joint Surgery, Inc.
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Removal of Painful Orthopaedic Implants After Fracture Union

Reuven B. Minkowitz, MD1, Siraj Bhadsavle, MD2, Michael Walsh, PhD1 and Kenneth A. Egol, MD1

1 New York University-Hospital for Joint Diseases, 301 East 17th Street, New York, NY 10003. E-mail address for R.B. Minkowitz: RubieMinkMD{at}yahoo.com
2 Department of Orthopaedic Surgery, Albany Medical Center, 107 Wellington Avenue, Albany, NY 12203

Investigation performed at the Department of Orthopaedic Surgery, New York University-Hospital for Joint Diseases, New York, and the Department of Orthopaedic Surgery, Albany Medical Center, Albany, New York

Disclosure: The authors did not receive any outside funding or grants in support of their research for or preparation of this work. Neither they nor a member of their immediate families received payments or other benefits or a commitment or agreement to provide such benefits from a commercial entity. Commerical entities (Stryker, Synthes, Biomet, and Richards) paid or directed in any one year, or agreed to pay or direct, benefits in excess of $10,000 to a research fund, foundation, division, center, clinical practice, or other charitable or nonprofit organization with which one or more of the authors, or a member of his or her immediate family, is affiliated or associated.

Background: Persistent pain in the region of implanted hardware following fracture fixation commonly leads to implant removal. This prospective study evaluated patient outcomes and pain reduction following removal of orthopaedic hardware implanted for fracture fixation.

Methods: Sixty patients who had been treated previously for a fracture and complained of pain in the region of the fracture fixation hardware constituted the study cohort. Patients were carefully examined by the treating physician to rule out other causes of pain such as infection and nonunion. Baseline data were recorded preoperatively. Data obtained postoperatively at three, six, and twelve months included a visual analog pain scale score and results on the Short Musculoskeletal Function Assessment Questionnaire and the Medical Outcomes Study Short Form-36. At the one-year interval, a patient satisfaction questionnaire was completed and outcomes were analyzed.

Results: There were no complications associated with implant removal surgery. Three patients did not have complete follow-up, leaving a total of fifty-seven patients with complete follow-up. At one year, all patients indicated that they were satisfied, that they would have the procedure done again, and that their overall function had improved. The scores for pain on the visual analog scale decreased from a mean (and standard deviation) of 5.5 ± 2.5 before hardware removal to 1.3 ± 1.8 after hardware removal, with an overall improvement at one year of 76% (p = 0.00001). At one year, thirty (53%) of the fifty-seven patients had complete resolution of pain. In addition, the results on the Short Musculoskeletal Function Assessment Questionnaire showed a 43% improvement from baseline (p = 0.0001), and the results on the physical component of the Short Form-36 showed a similar improvement of 40% (p = 0.0001).

Conclusions: Following fracture-healing, removal of hardware is safe with minimal risk. Improvement in pain relief and function can be expected.

Level of Evidence: Therapeutic Level IV. See Instructions to Authors for a complete description of levels of evidence.


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