As a shoulder and elbow surgeon a lot of operations that I perform involve implanting hardware to help solve someone’s problem. Examples of hardware include plates and screws, joint replacement implants and arthroscopic anchors.
When someone asks whether hardware needs to be removed in the future they usually are referring to plates and screws that help hold fractures together.
It is not always clear whether patients should have hardware removed after healing is complete. However there are a few instances when it is absolutely necessary to take out hardware. Below is a list of a few of those reasons.
- Infection
Unfortunately sometimes people get infections around hardware. In that case it’s usually necessary to take out the hardware to totally cure the infection. Bacteria like to stick to implants and they have very sneaky defenses that allow them to stick to metal and not let go.Unless you remove the hardware in those cases, the infection can linger.
- Tissue irritation
This one is variable. Some implants bother some people and not others. It really depends on where it is in your body.This year I have removed 4 collarbone plates. One was a type of implantwhich is meant to be temporary. The other 3 were ones that could have been permanent but the patients wanted them to be removed. One woman whose plate I removed felt the plate when she was trying to carry a bag on her shoulder. This bothered her. The collarbone is a very superficial. If you are skinny, it can be easy to feel the plate through your skin.
Another area that I operate on frequently in which the bone is superficial is the back of the elbow.
A few rules of thumb about elective plate removal:
- You should usually wait about a year after a fracture to insure that the bone is fully healed
- Removal of hardware doesn’t always relieve pain
- You can usually keep your hardware if you desire. Occasionally hospitals will disallow it for “policy” reasons. But if you want to make a Christmas ornament out of plates and screws or post them on Facebook that’s your prerogative as far as I am concerned. If the hospital lets you keep the hardware the OR staff will clean them prior to giving them back.
- It was never meant to be permanent.
Occasionally I will place hardware in someone that was never meant to stay forever. Examples are some pins to treat fractures or hook plates. I will let you know ahead of time if I am going to use these types of implants so that you can know what to expect. Some can come out in the office. Some require another operation.
Hook plates are a particular type of plate for fixing some AC joint injuries and fractures. I use them rarely, only when no other good option is available. They do work well, but they can cause rotator cuff irritation and other problems and must come out. So I try to avoid them if possible.
Take home message for patients:
Most implants that we use are compatible with your body and meant to stay for life. They usually don’t have to come out unless there is some good reason. Some implants were never meant to stay forever and your doctor should alert you to this at the time of surgery.
*I perform adult orthopedic surgery. And the above comments may not be generalizable to the pediatric population.