Many patients have questions about the hardware that is used in foot and ankle surgery. Talk to your foot and ankle orthopaedic surgeon before
surgery if you have any concerns.
Implants are substances that are placed inside or on the surface of the body. In the field of orthopaedics and in foot and ankle surgery in particular, implants refer to objects that are used to hold bones together, strengthen tendons and ligaments or attach them to bone, and replace bone.
Implant material depends on the application. There are two main groups: biologic and non-biologic.
Biologic materials are similar to human tissue and used primarily to replace or strengthen damaged tissue, such as bone or tendons. It also includes materials which eventually transform to scar and thus "disappear" over time.
Non-biologic implants are made from materials that are not intended to change over time. Examples include screws and plates. Over the last few decades these implants have been made of metals but recently use of plastics and composite materials has increased.
Plates and screws are made from either stainless steel or titanium alloys. There is no real benefit to one material over the other unless a patient has an allergy to a specific metal. It is largely a matter of surgeon preference. There can be variability in cost, design, and size among implants. Some hardware is specifically designed for a certain part of the foot or ankle while others have more applications. Your doctor will help decide which is the most appropriate implant for you.
No. As a general rule, implants do not rust, move, poison your system or have other negative consequences. However, occasionally an implant may cause pain or limit motion after it has served its purpose. It may be recommended to have it removed after the tissues have healed sufficiently.
Not with the current sensitivities of these testing devices. It would require a very large amount of material to be detectable.
There is no evidence that the current implants used in orthopaedic surgery result in an increased risk of infection. Surgery itself results in disruption of the blood supply and other damage to structures in the area and there is an increased risk of infection simply to place the implant. Previous trauma can compound this. There is continued debate within the medical community about whether hardware in the area is a benefit or detriment to successful treatment of orthopaedic infection. If bones have healed and infection is suspected, removal of the hardware usually is warranted. The decision to remove hardware is best handled on a case-by-case basis.
If the bone stabilized by the hardware doesn’t heal, hardware may break due to the stresses on the implants. The effect is similar to that of repetitively bending a paper clip back and forth. The presence of a broken implant is not necessarily a disaster. Sufficient healing may take place after the screw has broken to achieve structural stability. In some cases, it is anticipated that hardware will break or loosen. This can cause concern when seen on an X-ray but may not be associated with symptoms or other consequences.
Original article by F. Ray Nickel, MD
Contributors/Reviewers: Robert Leland, MD; Michael Greaser, MD
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