Many foot and ankle procedures require insertion of metal plates, screws, rods, or similar implants for stabilization of the bones while they heal. There are a number of reasons why your foot and ankle orthopaedic surgeon may chose to remove this hardware. Hardware can be removed if it is painful or associated with an infection, or if your bone didn't heal as hoped, which may require new hardware to be placed.
The goal of the procedure is to safely remove the hardware without causing damage to the surrounding soft tissues. These tissues often are scarred from previous surgery. Nerves and blood vessels and other soft tissue structures in this area may be at greater risk than at the time of the original surgery. A larger incision than the original surgical incision may be required to safely remove the hardware.
There are several reasons why your surgeon may recommend removing hardware. Pain due to hardware is the most common reason. In some cases, hardware may be placed across a joint to allow for proper healing, with the intention of removing the hardware at a later date to restore the motion at the joint. Other reasons include infection, nerve damage due to scarring, incomplete healing of the bone (called a non-union), or an allergy to the implant. If you have a metal allergy, it is important to let your surgeon know before surgery, as special implants may be used to minimize complications.
Your surgeon will usually use the previous incisions to find and remove the hardware. In some cases these incisions are made longer or additional incisions are made to safely perform the operation.
Hardware removal often is combined with other procedures. If there is an infection, your surgeon will remove the infection with a procedure called debridement. Nerves can be injured during the healing process due to scarring. If this occurs, the nerve can be freed from the scarring with a procedure called a nerve decompression.
When bone has not healed, further stabilization or correction may be performed. Different implants may be used and sometimes bone grafting is performed to try to get the bone to heal. An allergy to metal is uncommon, but when it occurs, the hardware is removed and sometimes a different type of metal is used. In general, an attempt is made to keep the hardware in place after surgery so the bone can heal. It can be removed later if necessary.
You should always ask your surgeon before an operation about your restrictions afterward. There are times when you may be allowed to put some weight on the limb during your recovery, but it is important to ask about this first.
All surgeries come with possible complications, including the risks associated with anesthesia, infection, damage to nerves and blood vessels, and bleeding or blood clots. The most common risks following hardware removal are infection, nerve damage, re-fracture (breaking the bone again), and the risks of anesthesia. Discuss these possibilities with your surgeon before surgery and ways to help avoid them.
There may be scar tissue from the original surgery which makes the identification of nerves or other structures in the area difficult during the surgical exposure. This at least slightly increases the risk of damage to these structures. Sometimes the hardware is difficult to identify as it is covered with scar or bone. It may require a greater amount of dissection to be uncovered. It may be so fixed in the bone that it has to be chiseled or drilled out. Removal may weaken the structure that the implant was securing, at least temporarily. In some cases, hardware may break as it is being removed. If broken hardware is buried deep within the bone it may be left in place since the risks of removing it outweigh the benefits.
Unfortunately, the only way to fully know if retained hardware is causing pain is to remove it and reassess symptoms. While not a true risk, continued pain after hardware removal is a possibility.
It could, but it depends on how much hardware was used and how sensitive the metal detector is. Joint replacements typically will be detected. Plates, screws, and similar implants may not be detected.
Many factors influence this. A small screw or wire may require little or no limitation of activity. High stress activities such as marathon training and jumping might be restricted for a period of time. Removal of ankle fixation hardware may require usage of a walking cast boot or similar brace for four weeks. Your surgeon will tell you whether any precautions are needed.
The space occupied by the implant does not convert to normal bone, at least initially. It fills in with dense scar that structurally is similar to bone. The holes left in the bone do not typically put the healed bone at a significant risk for refracture. In individuals who have not completed their growth, it may quickly fill in with bone.
It depends on the site and the individual factors. Hardware placed in areas without significant soft tissue coverage (muscle, fat) that come in contact with direct pressure from shoes is more likely to cause irritation. Screws flush with the bone usually don't cause pain.
Original article by Gladys Ka Yan Chan, MD
Contributors/Reviewers: Andrew Rosenbaum, MD; Michael Greaser, MD
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