Impact of Long-Term Retained Bone Screws on Mobility and Health Risks

Q: Impact of Long-Term Retained Bone Screws on Mobility and Health Risks

Hello： The principle is to remove internal bone screws and plates; however, many individuals do not have them removed. <br>This decision is related to the patient's age, the location of the screws (such as whether they are embedded within a joint), and the patient's symptoms. <br

Will having thigh and knee bone screws left in for about 20 years affect mobility in the future?

I was involved in a severe car accident in 1993, resulting in fractures of both hip joints, the right femur, the left knee joint, and the left tibia.
After multiple surgeries, both the hip and knee joints were stabilized with a total of 11 bone screws, and a steel rod was inserted into the right femur.
After a period of rehabilitation, my mobility is currently considered normal, although I cannot bend my left knee to a normal angle.
I return to the hospital annually for X-ray examinations.
Many years ago, a doctor informed me that due to the close proximity of the bone screws, it was not advisable to remove them, so no further action has been taken to date.
During my recent follow-up visit, the physician mentioned that if there is no discomfort, it is not a concern, noting that some individuals have not had their screws removed for 50 years.
If I were to consider removal now, it might not be feasible.

I would like to ask the physician:
1.
Will the long-term presence of bone screws and the steel rod in my body cause any future complications or impair my ability to walk?
2.
Regarding the material of the bone screws used approximately 20 years ago (when I opted for a higher quality material at my own expense), will there be any material degradation?
3.
Based on your professional judgment, is removal not a viable option? Additionally, what potential complications could arise, and what would be the most severe consequences? I often worry about this situation and would greatly appreciate your analysis and answers.
Thank you very much!

daniel, 50~59 year old female. Ask Date: 2011/12/15

Dr. Zhang Jiahao reply Orthopedics

Hello: The principle is to remove internal bone screws and plates; however, many individuals do not have them removed.
This decision is related to the patient's age, the location of the screws (such as whether they are embedded within a joint), and the patient's symptoms.
Since it has been twenty years, removal may theoretically be more challenging.
I recommend providing X-ray images to give you the most accurate advice.

Reply Date: 2011/12/15

More Info

The long-term retention of bone screws and other orthopedic hardware can raise several concerns regarding mobility and potential health risks. Your situation, involving multiple fractures and the placement of numerous screws and rods, is not uncommon in severe trauma cases. Here’s a comprehensive analysis of your questions based on current medical knowledge.

1. Impact of Long-Term Retained Hardware: Generally, bone screws and rods are designed to be biocompatible, meaning they should not cause significant adverse reactions when implanted in the body. However, there are potential risks associated with long-term retention. Over time, the hardware can lead to complications such as infection, irritation of surrounding tissues, or even mechanical failure. In some cases, the screws can migrate or loosen, which may necessitate surgical intervention. However, if you are currently asymptomatic and your X-rays show no signs of complications, the risks of leaving the hardware in place may be lower than the risks associated with removal surgery.
2. Material Changes Over Time: The materials used in orthopedic screws and rods, such as titanium or stainless steel, are designed to withstand the body's environment without significant degradation. However, factors like corrosion, especially in the presence of bodily fluids, can occur, albeit rarely. If you had opted for a higher-grade material, it is likely that it has maintained its integrity over the years. Nonetheless, regular monitoring through X-rays is essential to ensure that there are no signs of wear or failure.

3. Possibility of Removal: The decision to remove hardware is often based on symptoms and the potential for complications. If your doctor has assessed that the screws are not causing any issues and you are functioning well, they may recommend against removal. Surgical removal can carry its own risks, including infection, nerve damage, or complications related to anesthesia. If the screws are deeply embedded or if they are in close proximity to vital structures, removal may be more complicated and risky.

4. Potential Long-Term Effects: While many individuals live with retained hardware without significant issues, there are cases where complications can arise. These may include chronic pain, limited range of motion, or even the development of arthritis in the affected joints. In your case, the inability to fully bend your left knee could be related to the hardware or the original injury. It’s crucial to differentiate whether this limitation is due to the hardware or if it stems from the original injury and subsequent healing.

5. Severe Outcomes: In the most severe cases, retained hardware can lead to complications that might affect mobility, such as infections that require extensive treatment or hardware failure that necessitates further surgery. However, these scenarios are relatively rare, especially if you are currently asymptomatic.

In conclusion, while the long-term retention of bone screws and rods can pose some risks, many patients live with them without significant issues. Regular follow-ups with your orthopedic surgeon and imaging studies are essential to monitor the condition of the hardware and surrounding tissues. If you have ongoing concerns or experience new symptoms, it’s important to discuss these with your healthcare provider, who can provide tailored advice based on your specific situation.

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