The case against routine metal removal

Abstract

Metal removal is one of the most commonly performed operations in pediatric orthopedics. Many of these operations are performed electively in asymptomatic patients. In a retrospective study of 138 patients who had metal removal operations, the indication for surgery was uncomplicated healing in 69%. The overall complication rate was 13%, including incomplete removal in 7% and refracture in 1.4% after metal removal. Operations to remove metal from the proximal femur were associated with the highest complication rates, especially in patients with slipped capital femoral epiphysis. In a comparison of the risks associated with metal removal operations and the risks of long-term metal retention, little evidence was found to support a policy of routinely removing asymptomatic implants after the completion of bone healing.