title: Indications for implant removal after fracture healing: a review of the literature.
abstract: BACKGROUND
  The aim of this review was to collect and summarize published data on the indications for implant removal after fracture healing, since these are not well defined and guidelines hardly exist.
  
  
  METHODS
  A literature search was performed.
  
  
  RESULTS
  Though there are several presumed benefits of implant removal, such as functional improvement and pain relief, the surgical procedure can be very challenging and may lead to complications or even worsening of the complaints. Research has focused on the safety of metal implants (e.g., risk of corrosion, allergy, and carcinogenesis). For these reasons, implants have been removed routinely for decades. Along with the introduction of titanium alloy implants, the need for implant removal became a subject of debate in view of potential (dis)advantages since, in general, implants made of titanium alloys are more difficult to remove. Currently, the main indications for removal from both the upper and lower extremity are mostly 'relative' and patient-driven, such as pain, prominent material, or simply the request for removal. True medical indications like infection or intra-articular material are minor reasons.
  
  
  CONCLUSIONS
  This review illustrates the great variety of view points in the literature, with large differences in opinions and practices about the indications for implant removal after fracture healing. Since some studies have described asymptomatic patients developing complaints after removal, the general advice nowadays is to remove implants after fracture healing only in symptomatic patients and after a proper informed consent. Well-designed prospective studies on this subject are urgently needed in order to form guidelines based on scientific evidence.
authors.affiliation: Department of Surgery, Amphia Hospital Breda, P.O. Box 90158, 4800 RK, Breda, The Netherlands. dvos@amphia.nl.
authors.forename: D I
authors.initials: DI
authors.lastname: Vos
authors.affiliation: Department of Trauma Surgery, Erasmus University Medical Centre, P.O. Box 2040, 3000 CA, Rotterdam, The Netherlands.
authors.forename: M H J
authors.initials: MH
authors.lastname: Verhofstad
keywords: Fracture healing; Hardware removal; Implant removal; Indications; Metal implants; Osteosynthesis
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