title: Complications following implant removal in patients with proximal femur fractures - an observational study over 16 years.
abstract: BACKGROUND
  Fractures of the proximal femur commonly occur but the majority of orthopaedic surgeons do not consider general hardware removal as a routine necessity. Indications and time interval for hardware removal in this special selected patient group is still controversial. Therefore we performed a retrospective study to address the following questions: 1) Is there a difference between the medically- (infection, mechanical problems, implant failure) and non-medically indicated group (patients demand, meteoro-sensitivity, foreign body sensation) in relation to complications? 2) Is there a correlation regarding time interval between implantation and removal comparing these two groups? 3) Is there a context related refracture rate? 4) Should non-medically indicated implant removal (IR) be performed due to persistent pressure from the patient?
  
  
  OBJECTIVE
  We hypothesized that non-medically indicated implant removals should be avoided due to a significantly higher number of associated complications.
  
  
  METHODS
  A total of 371 consecutive patients with 424 hardware removal procedures following a proximal femur fracture, between 08/1992 and 11/2008, have been included. Study population was divided into two groups according to their indication for implant removal: medically indicated group (MIR) consisted of 299 patients (80.59%) and 72 patients (19.41%) were assigned to the non-medically indicated (NMIR) group.
  
  
  RESULTS
  In the NMIR subgroup a total of (n = 21) 28% complications occurred compared to 11.46% in the MIR subgroup; (P < 0.005), 86.51% of IR in the MIR group were performed within 1.5 years, compared to 79.17% in the NMIR group after 2 to 3.5 years (NS). In the MIR group 1 refracture occurred, compared to 4 in the NMIR group (NS).
  
  
  CONCLUSIONS
  Non-medically indicated implant removal should be avoided due to the higher complication rate of 28%. Surgeons and patients should be aware of the imminent complications and therefore implant removal should only be performed for good medical reasons.
  
  
  METHODS
  Level IV. Historical case study.
authors.affiliation: Department of Trauma Surgery, General Hospital Vienna, Medical University Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria. Electronic address: florian.kovar@meduniwien.ac.at.
authors.forename: F M
authors.initials: FM
authors.lastname: Kovar
authors.affiliation: Department for Neurosurgery, University Hospital St. Poelten, Probst Fuehrer-Srasse 4, 3100 St. Poelten, Austria.
authors.forename: E
authors.initials: E
authors.lastname: Strasser
authors.affiliation: Department of Trauma Surgery, General Hospital Vienna, Medical University Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria.
authors.forename: M
authors.initials: M
authors.lastname: Jaindl
authors.affiliation: Muehl-Speiser Laboratories GmbH, Praterstrasse 22, 1020 Vienna, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Endler
authors.affiliation: Department of Trauma Surgery, General Hospital Vienna, Medical University Vienna, Waehringerguertel 18-20, 1090 Vienna, Austria.
authors.forename: G
authors.initials: G
authors.lastname: Oberleitner
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D020878:Device Removal; D005260:Female; D005264:Femoral Fractures / Q000601:surgery*; D005500:Follow-Up Studies; D005593:Fracture Fixation, Internal / Q000009:adverse effects / Q000295:instrumentation*; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D019564:Unnecessary Procedures; D055815:Young Adult
keywords: Complications; Hip fracture; Implant removal