Evidence-based analysis of removal of orthopaedic implants in the pediatric population.
BACKGROUND
Requested project of the Pediatric Orthopaedic Society of North America Evidenced-Based Medicine Committee.


METHODS
The English literature was systematically reviewed for scientific evidence supporting or disputing the common practice of elective removal of implants in children.


RESULTS
Several case series reported implant removal, but none contained a control group with retained implants. No articles reported long-term outcomes of retained implants in large numbers. Several small series describe complications associated with retained implants without evidence of causation. The existing literature was not amenable to a meta-analysis. By compiling data from the literature, it is possible to calculate a complication rate of 10% for implant removal surgery. The complication rate for removal of implants placed for slipped capital femoral epiphysis is 34%. Articles regarding postmarket implant surveillance and basic science were also reviewed.


CONCLUSIONS
There is no evidence in the current literature to support or refute the practice of routine implant removal in children.
Raney
Ellen M
EM
Shriners Hospitals for Children-Honolulu, Honolulu, HI, USA. eraney@shrinenet.org
Freccero
David M
DM
Dolan
Lori A
LA
Lighter
Donald E
DE
Fillman
Ramona R
RR
Chambers
Henry G
HG
D002648:Child; D020878:Device Removal / Q000009:adverse effects / Q000379:methods*; D019317:Evidence-Based Medicine; D006801:Humans; D009984:Orthopedic Fixation Devices; D019637:Orthopedic Procedures / Q000009:adverse effects / Q000379:methods*; D011183:Postoperative Complications / Q000453:epidemiology / Q000209:etiology; D016896:Treatment Outcome