ArticleInternational orthopaedics2025
Implant removal: benefits and drawbacks - Results of a survey with five hundred participants from the Italian Society of Orthopedic Surgery and Traumatology (SIOT) and comparison with other international trends.
Article in International orthopaedics, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. An erratum has been issued. Cited by 4 papers, 1 of them a synthesis that pooled it.
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Who cites it
4 citing papers in PubMed, 1 synthesis or guideline pooled it.
- Iatrogenic complications in the removal of humeral intramedullary nails: a systematic review.BMC surgery · 2026Pooled it
- [Practical guidelines for difficult and complex hardware removal in orthopedic surgery].Operative Orthopadie und Traumatologie · 2026Article
- Double mini-locking plates for unstable Danis-Weber B distal fibular fractures: superior functional outcomes and lower implant removal rates.Journal of orthopaedic surgery and research · 2026Article
- Predictors for complications and the removal of osteosynthesis material after mandibular fractures: a retrospective analysis.BMC oral health · 2026Article
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- Erratum issued
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5 authors.
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No grant is acknowledged in the PubMed record.
Abstract
introductionImplant removal in orthopedics and traumatology is still a controversial topic. Benefits and drawbacks lead to relative indications, mainly depending on patients' demands and surgeons' perspectives. This study aims to report the current attitudes and practices of Italian surgeons who participated in a survey. MATERIALS AND
methodsAn online-based questionnaire of 25 items was distributed to all the members of the Italian Society of Orthopedic Surgery and Traumatology (SIOT) regarding their indications, usual practices, and complications encountered with hardware removal in upper and lower limbs. The survey was open from July 2024 to October 2024. Exclusion and inclusion criteria were applied.
resultsFive hundred answers were received. While implant removal is primarily achieved in symptomatic patients, in the case of asymptomatic patients, it is not routinely performed, with a slightly higher tendency of removal in those aged 16-40 years old. These tendencies were registered both for the upper and lower limbs, with more reticence in hardware removal in the upper limbs. 96% of respondents declared the lack of hospital guidelines regarding this kind of surgery. The most feared intraoperative complications during the removal concerned screw stripping and implant breakage, with only 0.6% of respondents reporting no intraoperative difficulties. While patient discomfort and avoidance of future complications were the main indications for removal, postoperative complications occurred as wound scarring concerns, persistence of symptoms and bleeding. Despite not being considered a "procedure for the resident", when residents were specifically questioned, in 76% of cases they felt self-confident ≥ 7 on a scale from 1 to 10. Lastly, according to 62% of the respondents, titanium implants are more difficult to remove than stainless steel ones.
conclusionThis survey describes a general tendency to not routinely remove implants, even in younger patients in the lower and especially upper limbs, unless in case of symptoms. Hardware removal could evolve from a simple procedure into a more complex surgery due to intraoperative technical difficulties. A lack of universal policy and guidelines exists throughout the Italian territory.
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