Orthopedic Surgery for Removing Hardware

While removing old hardware implanted in the body may seem straightforward, it can be one of the more challenging orthopedic procedures. In fact, many orthopedic surgeons describe hardware removal to new trainees and residents to be "the most difficult procedure."

In reality, hardware removal is probably not the most difficult surgery—complex spine surgery, correction of congenital deformities, reconstruction of damaged joints—are all difficult, time-consuming surgical procedures. However, hardware removal surgery often lulls the unsuspecting surgeon, and patient, into thinking the surgery will be quick and easy. While it may turn out to be simple, hardware removal surgery has the propensity to be much more challenging than anticipated.

Why Remove Hardware?

In the vast majority of patients with metal in the body, there is no need to remove the metal. Metal implants are generally designed to remain in place forever. However, there are some circumstances where metal should be removed. These include temporary metal devices only intended to be in the body for a short time, loose metal, or metal that may need to be removed to allow for additional surgery.

The bottom line is, there should always be a good reason to remove metal from the body because needless hardware removal can open the door to possible complications of surgery.

Complications of Hardware Removal

• Infection: The most obvious reason to avoid an unnecessary surgical procedure is the possibility of infection.  While infection is rare when removing hardware (and infection may be a reason to remove metal), it is certainly possible, and whenever a surgery is not absolutely necessary, you should consider if it is worth the risks.
• Weakening of bone: Most metal implants are secured in the bone. In order to remove the implant from the bone, there is typically a weakening of the bone. Screws removed to leave a hole in the bone, plates may leave a deformity in the bone. Removing these implants may weaken the bone where the implant was used.
• Damage to the body: In order to remove an implant, tissues, and bone surrounding the implant must be moved. This can damage the muscle and other tissues in the body. Often bone and soft-tissue grow into and around implants, making them more difficult to remove as time goes on.
• Inability to remove the implant: This is the most concerning issue and a concern any orthopedic surgeon who has been working for more than a short time has faced. Difficulty removing an implant can occur if the implant is difficult to locate, if the implant breaks, or in some cases if it is simply stuck. While you can always do more to remove the implants, sometimes the damage to normal bone and soft-tissue becomes not worthwhile to remove the old metal. In these rare circumstances, the effort to remove an implant may be abandoned and the implant, or part of it, left behind.

When Hardware Should Be Removed

There are times when hardware removal can lead to significant benefits. When implanted metal is causing interference with normal joint mobility and function, or if metal implants are causing pain or irritation to soft-tissues, their removal can be beneficial.

In some cases, the hardware is routinely removed to prevent possible problems, and in other cases, the metal is only removed if it begins to cause a problem. There are also times when hardware removal becomes impossible.

This is often the case when there is a broken metal implant inside the body, which can be normal or expected in some cases after the surrounding bone has healed, and not necessarily a problem for the patient.

A Word From Verywell

The reality is, most metal implants can be removed, but many don't have to be. There is always potential that what is seemingly going to be a simple, straight-forward surgical procedure may become much more complicated. For that reason, patients should be wary of a hardware removal surgery, and make sure it is necessary and worth the risks.