Many foot and ankle surgeries involve the insertion of metal plates, screws, rods, or similar implants to stabilize the bones during healing. There are various reasons Dr. Kamel might choose to remove this hardware. Common reasons include pain, infection, or incomplete bone healing, which might necessitate replacing the hardware.
Purpose of Hardware Removal
The main goal of hardware removal is to extract the implants safely without damaging the surrounding scarred soft tissues. This can be challenging, as nerves, blood vessels, and other tissues might be at higher risk than during the initial surgery. Often, a larger incision than the original one is needed to ensure safe removal.
Diagnosis
Dr. Kamel may recommend hardware removal for several reasons:
- Pain: The most common reason for hardware removal.
- Joint Mobility: Hardware might be placed across a joint for healing and removed later to restore joint motion.
- Infection: Hardware may be removed to eliminate infection.
- Nerve Damage: Scarring can damage nerves, necessitating hardware removal.
- Non-Union: Incomplete bone healing, requiring new stabilization.
- Allergy: Metal allergies might require special implants; notify your surgeon if you have a metal allergy.
Treatment
Dr. Kamel typically uses the previous incisions for hardware removal. Sometimes, these incisions are extended, or additional incisions are made for safe removal.
Hardware removal can be combined with other procedures. For example:
- Debridement: Removing infection from the area.
- Nerve Decompression: Freeing nerves from scar tissue if injured during healing.
- Stabilization or Bone Grafting: If the bone hasn't healed, different implants or bone grafting might be needed.
- Addressing Metal Allergy: Removing hardware and possibly using a different type of metal.
Recovery
Post-surgery restrictions vary. Always ask Dr. Kamel about your specific limitations. Sometimes, partial weight-bearing on the affected limb is allowed during recovery, but confirm with Dr. Kamel first.
Risks and Complications
All surgeries carry risks, including anesthesia complications, infection, nerve and blood vessel damage, and bleeding or blood clots. Specific risks after hardware removal include:
- Infection
- Nerve Damage
- Re-Fracture: The bone might break again.
- Anesthesia Risks
Scar tissue from the original surgery can make it difficult to identify nerves or other structures, slightly increasing the risk of damage. Hardware might be covered by scar tissue or bone, requiring extensive dissection. Sometimes, hardware is so fixed it must be chiseled or drilled out, which can temporarily weaken the bone structure. Occasionally, hardware might break during removal. If deeply buried, broken hardware may be left in place if the risks of removal outweigh the benefits.
Determining if retained hardware is causing pain can only be confirmed by removal and reassessment of symptoms. Continued pain after hardware removal is a possibility.
Metal Detectors and Implants
Your metal implant might set off a metal detector, depending on the amount and type of hardware used and the sensitivity of the detector. Joint replacements typically get detected, while plates and screws may not.
Precautions After Hardware Removal
The extent of precautions needed after hardware removal depends on several factors. Small screws or wires might require minimal activity limitations. High-stress activities, such as marathon training, might be restricted temporarily. Removal of ankle fixation hardware could necessitate using a walking cast boot or similar brace for about four weeks. Dr. Kamel will provide specific precautions if needed.
Healing After Hardware Removal
The space previously occupied by the implant initially fills with dense scar tissue, structurally similar to bone. The holes left in the bone usually don't significantly increase the risk of re-fracture. In growing individuals, these spaces might quickly fill with new bone.
Frequency of Hardware Removal
The necessity for hardware removal depends on the location and individual circumstances. Hardware in areas with minimal soft tissue coverage, which might come into contact with shoe pressure, is more likely to cause irritation. Screws flush with the bone typically do not cause pain.