title: Do orthopaedic surgeons need a policy on the removal of metalwork? A descriptive national survey of practicing surgeons in the United Kingdom.
abstract: BACKGROUND
  Routine metalwork removal, in asymptomatic patients, remains a controversial issue. Current literature emphasises the potential hazards of implant removal and the financial implications encountered from these procedures. However, there is little literature guidance and no published research on current practice.
  
  
  OBJECTIVE
  To estimate the current state of practice of orthopaedic surgeons in the United Kingdom regarding implant removal in asymptomatic patients.
  
  
  METHODS
  An analysis, by two independent observers, was performed on the postal questionnaire replies of 36% (500 out of 1390), randomly selected UK orthopaedic consultants.
  
  
  RESULTS
  Four hundred and seven (81%) replies were received. A total of 345 (69%) were found to be suitable for analysis. The most significant results of our study (I) 92% of orthopaedic surgeons stated that they do not routinely remove metalwork in asymptomatic skeletally mature patients; (II) 60% of trauma surgeons stated that they do routinely remove metalwork in patients aged 16 years and under; (III) 87% of the practicing surgeons indicated that they believe it is reasonable to leave metalwork in for 10 years or more; (IV) only 7% of practicing trauma surgeons who replied to this questionnaire have departmental or unit policy.
  
  
  CONCLUSIONS
  Our results demonstrate that most practicing trauma surgeons do comply with the evidence presented in the little literature available. However, we do believe that a general policy for metalwork removal is essential. Such a policy should include guidelines specific to age groups and level of surgeon who should be performing the removal procedure. Such a document would require further validated studies but would eventually serve to steer surgeons in achieving best practice.
authors.affiliation: Trauma and Orthopaedics, Bradford Royal Infirmary, UK. drwjamil@doctors.net.uk
authors.forename: W
authors.initials: W
authors.lastname: Jamil
authors.forename: M
authors.initials: M
authors.lastname: Allami
authors.forename: M Z
authors.initials: MZ
authors.lastname: Choudhury
authors.forename: C
authors.initials: C
authors.lastname: Mann
authors.forename: T
authors.initials: T
authors.lastname: Bagga
authors.forename: A
authors.initials: A
authors.lastname: Roberts
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D002648:Child; D020878:Device Removal / Q000706:statistics & numerical data*; D005121:Extremities / Q000293:injuries / Q000601:surgery; D005593:Fracture Fixation, Internal / Q000295:instrumentation* / Q000706:statistics & numerical data; D019538:Health Care Surveys; D006801:Humans; D008875:Middle Aged; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians' / Q000706:statistics & numerical data*; D019736:Prostheses and Implants; D006113:United Kingdom