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.