Removing Pins & Other Implants After Surgical Treatment

intramedually rod
This patient had a metal rod (intramedually rod) placed within her broken tibia to realign the bone and hold the tibia fracture in position. Photo © Jonathan Cluett, M.D.

Implanted metal can help broken bones heal properly. While these implants do not help the bone heal faster, they can help to hold bones in the proper position while healing takes place.  Once the healing has completed, those metal implants may not be needed any longer.  While implants are typically designed to stay in the body forever, they may not be needed, and they can potentially cause problems.

  Implants may include:

In most cases it is not necessary for implants to be removed. There are some exceptions where your doctor may recommend an implant removal. For example, some doctors recommend removal of syndesmotic screws (for high ankle sprains) before weight-bearing is resumed.  However, in most cases, implants can stay in the body without causing problems, and the removal of an implant should not be considered a "routine" part of treatment.

Removing Metal Implants

In some patients, metal implants can cause irritation to surrounding tissues. This may cause bursitis, tendonitis, or local irritation. In these cases, removal of the metal may relieve this irritation. Some of the signs of problematic metal include:

  • Pain directly at the location of the metal implant
  • Rubbing of the metal implant underneath the skin
  • Grinding sensations around the metal implant

    It can be very difficult to predict if removal of metal implants will improve symptoms of discomfort.  In patients who have pain that is clearly coming from irritation caused by the metal, the chance of pain reduction is much more likely. If the pain is more generalized, and not clearly an irritation, the chance of pain resolution with metal removal is more difficult to predict.

    There are potential complications of surgery to remove metal implants. The most common problem is metal removal can be quite difficult, especially with deep implants that have been in place a long time. Furthermore, removing the implant can lead to weakening of the bone where the implant was removed. For example, fractures through holes where screws were implanted are not uncommon. Discuss with your doctor the potential problems associated with implant removal.

    One other scenario where metal implants can cause significant problems are when an infection becomes an issue. Metal implants can become a source for persistent infection in the body. The reason is that your body cannot fight off infection on a metal implant because neither your immune defenses or antibiotic treatments can be delivered to the metal implant effectively. For this reason, metal implants can harbor persistent infection, prevent surgical wounds from healing, and cause other potential problems. In these situations, the metal implant may have to be removed, simply to cure an infection.

    Should Implants Be Removed?

    If you are having symptoms caused by metal irritation, then removal of the implant may be helpful. Your doctor can help you determine the chance that metal removal will alleviate your symptoms, as this needs to be evaluated on a case by case basis.

    Understand that removing the implants can have possible complications and may not make all symptoms of discomfort resolve.  That said, there are times where removing metal from inside the body can be an effect treatment for persistent problems following an orthopedic surgery.

    Sources:

    Busam ML, et al. "Hardware removal: indications and expectations" J Am Acad Orthop Surg. 2006 Feb;14(2):113-20.

    Brown OL, et al. "Incidence of hardware-related pain and its effect on functional outcomes after open reduction and internal fixation of ankle fractures." J Orthop Trauma. 2001 May;15(4):271-4.

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