Subjective outcomes and complication rates following elective implant removal: a prospective study on patient and surgeon perspectives.

backgroundWhile there are clear indications for osteosynthesis for different types of fracture, only few indications exist for routine implant removals (IR). Therefore, we suggest there is no significant difference in pain development or subjective improvement of function after an IR regardless of the indication. MATERIAL AND

methodsThis prospective single-center study includes all patients undergoing IR from 07/2014 to 06/2017. Questionnaires were filled out before IR as well as 3 and 12 months after surgery. There was an additional questionnaire for the surgeon before and after the surgery. Collected data included demographics as well as information about comorbidities, smoking status, surgeon's experience level, indication, complications, localization and type of implant, expectation, and perception of pain development as well as subjective change of function.

resultsA total of 237 patients with 322 implants were included in the study, of which 41% (n = 97) were female and 59% (n = 140) male. The average age was 45.4 ± 15.5 years at the time of IR. All categories showed significant improvement 3 and 12 months after IR. There was significant difference between different types of indication, localization, complication, and retention of implant. The willingness to repeat IR was high. Pedicle screws and tension band wiring stand out with low intraoperative complication rates. Some localizations, such as the upper arm, patella, and spine, tend to have lower intraoperative complication rates, while others, such as the thigh, pelvis, and forearm, are prone to higher intraoperative complication rates. Further factors, such as body-mass-index (BMI), smoking status, diabetes mellitus, and osteoporosis, showed no significant difference in intraoperative complication rates. Neither did different levels of surgeon's experience. Surgeon's expectation for functional improvement had a negative correlation with the patient's perception of functional improvement 3 months after IR.

conclusionDifferent complication rates were detected for different localizations and types of implant. Regardless of the indication most patients had a great benefit from an IR and would repeat it, given the choice. Perceived overall improvement does not correlate with the surgeon's expectation. Therefore, this study insists on an informed decision-making concept, which does not underestimate the patient's wish for an IR as a valid indication.