[Practical guidelines for difficult and complex hardware removal in orthopedic surgery].

Authors

Martin C Jordan, Justus Bremer, Abdul Al Refai, Felix Wolff, Georgi I Wassilew, Janosch Schoon, Stefan Zwingenberger, Philipp Heilig

Published in

Operative Orthopadie und Traumatologie. Sep 16, 2026. Epub Sep 16, 2026.

Abstract

Safe and complete removal of osteosynthesis materials while preserving the surrounding soft tissues.
Indications include implant-related pain, soft-tissue irritation, infection, implant failure, pseudarthrosis, and risk to adjacent tendons, nerves, or vessels as well as implants in children.
Disproportionate procedural risk in patients with poor bone quality, extensive scarring, or high surgical morbidity.
Thorough preoperative planning, precise identification of the implant type and manufacturer, and the availability of the manufacturer's original extraction tools as well as alternative extraction instruments-such as special extractors, carbide drills, and hollow reamers-are essential. In this article, stepwise removal techniques are detailed for screws, plates, intramedullary nails, and spinal or pelvic implants, including strategies for managing stripped, cold-welded, or fractured implants.
Early functional rehabilitation is encouraged. Following removal of load-bearing implants, temporary activity restrictions and postoperative X‑rays to detect iatrogenic fractures are recommended.
Implant removal is a frequent yet technically demanding procedure. Careful preparation, appropriate instrumentation, and meticulous technique reduce complications and enhance patient safety.

PMID:
42747457
Bibliographic data and abstract were imported from PubMed on 17 Sep 2026.

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