Challenges of Removing Long-Term Orthopedic Hardware After 27 Years

Pain while walking due to a fractured steel plate?

Hello Doctor: I suffered an open fracture of my right thigh in 1995.
A year after the surgery, I intended to have the steel plate and screws removed, but the doctor advised that it was unnecessary and I could live normally without removal.
Now, 27 years later, I experienced sudden severe pain in my right thigh while walking.
Upon examination, it was found that the steel plate had fractured, and I need to inject hyaluronic acid at the screw site to alleviate the pain.
I have consulted multiple doctors about the possibility of removal, but many seem hesitant.
I would like to ask you, after 27 years, is it difficult to remove the screws and plate? Could you recommend a hospital or doctor willing to perform the removal? Thank you very much, and I apologize if I have been disrespectful in any way.
I appreciate your help.

Mr. Li, 40~49 year old female. Ask Date: 2022/08/23

Dr. Shi Guozheng reply Orthopedics

If the metal plate has fractured, it is important to check for any associated bone fractures.
If there are no fractures, the metal plate can simply be removed.
However, if there is a fracture, a second surgery will be necessary to stabilize the bone.

Reply Date: 2022/08/23

More Info

The challenges of removing long-term orthopedic hardware, such as plates and screws, after many years can be significant. In your case, after 27 years of having the hardware in place following an open fracture of the right femur, there are several factors to consider regarding the removal of the hardware.

Firstly, the longer the hardware remains in the body, the more integrated it can become with the surrounding tissues. Over time, the body may form scar tissue around the hardware, and the bone may have adapted to the presence of the hardware. This integration can make the removal process more complex, as the surgeon may need to navigate through dense scar tissue and ensure that they do not damage surrounding structures, such as nerves and blood vessels.

Secondly, the condition of the hardware itself is crucial. In your case, you mentioned that the plate has fractured. This can complicate the removal process, as broken hardware may require additional techniques to extract. The surgeon may need to use specialized tools to remove the fractured pieces, which can increase the duration and complexity of the surgery.

Additionally, the condition of the bone surrounding the hardware is an important consideration. After such a long period, there may be changes in bone density or quality, especially if there has been any history of disuse or atrophy in the area. If the bone is weak or compromised, it may be more challenging to remove the hardware without causing further damage.

Pain management is also a critical aspect of this situation. As you have experienced pain due to the fractured plate, it is essential to address this before and after the surgery. Injections of hyaluronic acid, as you mentioned, can provide temporary relief, but they do not address the underlying issue of the broken hardware. A comprehensive pain management plan should be discussed with your healthcare provider.

Regarding the surgical procedure itself, it is advisable to seek out an orthopedic surgeon who specializes in the removal of hardware. Not all orthopedic surgeons may feel comfortable performing such a procedure, especially after such a long duration. It may be beneficial to consult with a surgeon who has experience in complex orthopedic revisions or one who works at a specialized orthopedic center.

In conclusion, while it is possible to remove long-term orthopedic hardware after many years, the procedure can be fraught with challenges. Factors such as integration with surrounding tissues, the condition of the hardware, the state of the surrounding bone, and pain management all play significant roles in the complexity of the surgery. It is crucial to have a thorough discussion with an experienced orthopedic surgeon who can assess your specific situation and provide you with the best options for treatment. They can also guide you through the risks and benefits of the procedure, ensuring that you make an informed decision about your care.

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