Should You Remove Plates and Screws After Orthopedic Surgery?

Should the plates and screws be removed?

In late February, I was involved in a car accident and had an interlocking plate fixed to my acetabulum.
A few days later, I underwent surgery for my tibia, which was stabilized with screws.
The doctor mentioned that if I don't feel any discomfort from the plates and screws, they do not need to be removed.
I am currently in rehabilitation.
I would like to ask the doctor: 1.
What are the advantages and disadvantages of removing versus not removing the hardware? 2.
If I decide to have them removed, how long after the initial surgery is it advisable to do so? Is the removal surgery difficult? How many days do patients typically stay in the hospital? Thank you.

Niming, 50~59 year old female. Ask Date: 2021/04/01

Dr. Chen Yongxue reply Orthopedics

Hello,
1.
What are the pros and cons of removing the plate versus not removing it? The metal plate is considered a foreign body in the human body.
At this stage, not removing it is unlikely to cause significant issues.
However, as one ages and the body's immune system weakens (due to conditions like diabetes or undergoing dialysis), if an infection occurs (such as a urinary tract infection or pneumonia), bacteria may easily colonize around the plate.
At that point, removing the plate could become quite challenging.
Therefore, I personally recommend that if the risks of anesthesia are low and the bone density is not excessively compromised, it would be better to have the plate removed.
2.
If removal is to be done, how long after the initial surgery is it advisable, and is the surgery difficult? The timing for removal depends on the healing of the fracture and the type of plate used.
Generally, for lower limb fractures, it is recommended to wait about a year and a half.
The surgery is not difficult, and the typical hospital stay is about two to three days.
Thank you.

Reply Date: 2021/04/01

More Info

When it comes to the decision of whether to remove plates and screws after orthopedic surgery, there are several factors to consider. Your situation, involving a hip joint surgery with an interlocking plate and a tibial fixation with screws, is not uncommon. Here’s a comprehensive overview of the pros and cons of removing hardware, as well as considerations for timing and the surgical process.

Pros and Cons of Removing Plates and Screws
Pros of Removal:
1. Pain Relief: Some patients experience discomfort or pain at the site of the hardware, especially if the hardware is prominent or if there are complications such as irritation of surrounding tissues. Removing the hardware can alleviate this discomfort.

2. Improved Range of Motion: In some cases, hardware can restrict movement, particularly if it is located near a joint. Removal may improve mobility and function.

3. Reduced Risk of Complications: If there is a risk of infection or if the hardware is causing issues (like migration or breakage), removal may be necessary to prevent further complications.

Cons of Removal:
1. Surgical Risks: Any surgical procedure carries risks, including infection, bleeding, and nerve or vascular injury. The removal of hardware is no exception.

2. Recovery Time: After removal, there is a recovery period during which you may experience pain and limited mobility. This can delay your rehabilitation process.

3. Potential for Nonunion: If the bone has not fully healed, removing the hardware could increase the risk of nonunion or malunion, where the bone does not heal properly.

Timing for Hardware Removal
The timing for hardware removal can vary based on individual circumstances, including the type of surgery, the healing process, and the presence of any complications. Generally, it is advisable to wait until the bone has fully healed, which can take anywhere from 6 months to a year, depending on the specific injury and the individual’s healing capacity.
If you are considering removal, consult with your orthopedic surgeon to assess the healing status of your bones through imaging studies (like X-rays or CT scans) and to discuss your symptoms.

Surgical Considerations
1. Surgical Difficulty: The complexity of the removal surgery can depend on various factors, including the location of the hardware, the type of fixation used, and the condition of the surrounding tissues. In some cases, the surgery may be straightforward, while in others, it may require more extensive dissection and care.

2. Hospital Stay: The length of hospital stay after hardware removal can vary. Many patients can go home the same day or after an overnight stay, but this depends on the specific procedure and your overall health.

3. Post-Operative Care: After the removal, you will likely need to follow a rehabilitation program to regain strength and mobility. This may involve physical therapy and gradual return to normal activities.

Conclusion
In summary, the decision to remove plates and screws after orthopedic surgery should be made in consultation with your orthopedic surgeon, taking into account your specific situation, symptoms, and overall health. Weighing the pros and cons, considering the timing for removal, and understanding the surgical process will help you make an informed decision. Always prioritize open communication with your healthcare provider to ensure the best possible outcome for your recovery.

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