{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,9]],"date-time":"2026-10-09T09:38:27Z","timestamp":1791538707673,"version":"4.3.4"},"reference-count":44,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"22","content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2021,11,17]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>While hardware removal may improve patient function, the procedure carries risks of unexpected outcomes. Despite being among the most commonly performed orthopaedic procedures, scant attention has been given to its complication profile.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We queried the American Board of Orthopaedic Surgery (ABOS) de-identified database of Part II surgical case lists from 2013 through 2019 for American Medical Association Current Procedural Terminology (CPT) implant-removal codes (20680, 20670, 22850, 22852, 22855, 26320). Hardware removal procedures that were performed without any other concurrent procedure (\u201cHR-only procedures\u201d) were examined for associated complications.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>In the 7 years analyzed, 13,089 HR-only procedures were performed, representing 2.1% (95% confidence interval [CI], 2.1% to 2.2%) of the total of 609,150 surgical procedures during that period. A complication was reported to have occurred in association with 1,256 procedures (9.6% [95% CI, 9.1% to 10.1%]), with surgical complications reported in association with 1,151 procedures (8.8% [95% CI, 8.3% to 9.3%]) and medical\/anesthetic complications reported in association with 196 procedures (1.5% [95% CI, 1.3% to 1.7%]). Wound-healing delay\/failure (2.1% [95% CI, 1.8% to 2.3%]) and infection (1.6% [95% CI, 1.4% to 1.8%]) were among the most commonly reported complications after HR-only procedures, but other serious events were reported as well, including unexpected reoperations (2.5% [95% CI, 2.2% to 2.7%]), unexpected readmissions (1.6% [95% CI, 1.4% to 1.8%]), continuing pain (95% CI, 1.2% [1.0% to 1.4%]), nerve injury (0.6% [95% CI, 0.4% to 0.7%]), bone fracture (0.5% [95% CI, 0.4% to 0.6%]), and life-threatening complications (0.4% [95% CI, 0.3% to 0.5%]).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Hardware removal is one of the most commonly performed orthopaedic procedures and was associated with an overall complication rate of 9.6% (95% CI, 9.1% to 10.1%) in a cohort of recently trained orthopaedic surgeons in the United States. Although specific complications such as infection, refractures, and nerve damage were reported to have relatively low rates of occurrence, and associated life-threatening complications occurred rarely, surgeons and patients should be aware that hardware removal carries a definite risk.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level IV<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.20.02231","type":"journal-article","created":{"date-parts":[[2021,8,16]],"date-time":"2021-08-16T16:29:40Z","timestamp":1629131380000},"page":"2089-2095","update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":58,"title":["Complications of Hardware Removal"],"prefix":"10.2106","volume":"103","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-5973-8013","authenticated-orcid":false,"given":"Patrick J.","family":"Kellam","sequence":"first","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3037-2748","authenticated-orcid":false,"given":"John","family":"Harrast","sequence":"additional","affiliation":[{"name":"Data Harbor Solutions, Chicago, Illinois"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-0721-7291","authenticated-orcid":false,"given":"Maxwell","family":"Weinberg","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8975-7031","authenticated-orcid":false,"given":"David F.","family":"Martin","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, Wake Forest Baptist Health, Winston-Salem, North Carolina"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-9592-5046","authenticated-orcid":false,"given":"Nathan P.","family":"Davidson","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2877-2339","authenticated-orcid":false,"given":"Charles L.","family":"Saltzman","sequence":"additional","affiliation":[{"name":"Department of Orthopaedic Surgery, University of Utah, Salt Lake City, Utah"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2021,8,16]]},"reference":[{"key":"bib1-20250430","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1186\/1471-2474-9-73","article-title":"Surgeons\u2019 beliefs and perceptions about removal of orthopaedic implants","volume":"9","author":"Hanson","year":"2008","journal-title":"BMC Musculoskelet Disord."},{"issue":"2","key":"bib2-20250430","doi-asserted-by":"crossref","first-page":"113","DOI":"10.5435\/00124635-200602000-00006","article-title":"Hardware removal: indications and expectations","volume":"14","author":"Busam","year":"2006","journal-title":"J Am Acad Orthop Surg."},{"issue":"9","key":"bib3-20250430","doi-asserted-by":"crossref","first-page":"1906","DOI":"10.2106\/00004623-200709000-00003","article-title":"Removal of painful orthopaedic implants after fracture union","volume":"89","author":"Minkowitz","year":"2007","journal-title":"J Bone Joint Surg Am."},{"issue":"3","key":"bib4-20250430","doi-asserted-by":"crossref","first-page":"362","DOI":"10.1016\/j.injury.2007.10.028","article-title":"Do orthopaedic surgeons need a policy on the removal of metalwork? A descriptive national survey of practicing surgeons in the United Kingdom","volume":"39","author":"Jamil","year":"2008","journal-title":"Injury."},{"issue":"4","key":"bib5-20250430","doi-asserted-by":"crossref","first-page":"510","DOI":"10.1097\/01.bpo.0000214924.02939.62","article-title":"Orthopaedic implants in children: survey results regarding routine removal by the pediatric and nonpediatric specialists","volume":"26","author":"Loder","year":"2006","journal-title":"J Pediatr Orthop."},{"issue":"1","key":"bib6-20250430","first-page":"1","article-title":"Indications of implant removal: A study of 83 cases","volume":"11","author":"Haseeb","year":"2017","journal-title":"Int J Health Sci (Qassim)."},{"issue":"4","key":"bib7-20250430","doi-asserted-by":"crossref","first-page":"170","DOI":"10.1177\/107110079401500402","article-title":"Removal of internal fixation\u2014the effect on patients\u2019 complaints: a study of 66 cases of removal of internal fixation after malleolar fractures","volume":"15","author":"Jacobsen","year":"1994","journal-title":"Foot Ankle Int."},{"issue":"4","key":"bib8-20250430","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1097\/00005131-200105000-00006","article-title":"Incidence of hardware-related pain and its effect on functional outcomes after open reduction and internal fixation of ankle fractures","volume":"15","author":"Brown","year":"2001","journal-title":"J Orthop Trauma."},{"issue":"2","key":"bib9-20250430","doi-asserted-by":"crossref","first-page":"103","DOI":"10.1097\/00005131-199702000-00006","article-title":"Knee pain after intramedullary tibial nailing: its incidence, etiology, and outcome","volume":"11","author":"Court-Brown","year":"1997","journal-title":"J Orthop Trauma."},{"issue":"1","key":"bib10-20250430","doi-asserted-by":"crossref","first-page":"10","DOI":"10.1097\/00005131-199701000-00004","article-title":"Knee pain after tibial nailing","volume":"11","author":"Keating","year":"1997","journal-title":"J Orthop Trauma."},{"key":"bib11-20250430","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1186\/s12893-015-0081-6","article-title":"Metal implant removal: benefits and drawbacks\u2014a patient survey","volume":"15","author":"Reith","year":"2015","journal-title":"BMC Surg."},{"issue":"5","key":"bib12-20250430","doi-asserted-by":"crossref","first-page":"738","DOI":"10.1302\/0301-620X.79B5.0790738","article-title":"Proximal thigh pain after femoral nailing. Causes and treatment","volume":"79","author":"Dodenhoff","year":"1997","journal-title":"J Bone Joint Surg Br."},{"issue":"4","key":"bib13-20250430","doi-asserted-by":"crossref","first-page":"327","DOI":"10.1007\/s00068-013-0283-5","article-title":"Indications for implant removal after fracture healing: a review of the literature","volume":"39","author":"Vos","year":"2013","journal-title":"Eur J Trauma Emerg Surg."},{"issue":"1","key":"bib14-20250430","doi-asserted-by":"crossref","first-page":"29","DOI":"10.1016\/0020-1383(92)90121-8","article-title":"Complications of metalwork removal","volume":"23","author":"Sanderson","year":"1992","journal-title":"Injury."},{"issue":"1","key":"bib15-20250430","doi-asserted-by":"crossref","first-page":"25","DOI":"10.1016\/0020-1383(92)90120-H","article-title":"Observations on removal of metal implants","volume":"23","author":"Richards","year":"1992","journal-title":"Injury."},{"issue":"4","key":"bib16-20250430","doi-asserted-by":"crossref","first-page":"601","DOI":"10.1302\/0301-620X.72B4.2380210","article-title":"Removal of forearm plates. A review of the complications","volume":"72","author":"Langkamer","year":"1990","journal-title":"J Bone Joint Surg Br."},{"issue":"9","key":"bib17-20250430","doi-asserted-by":"crossref","first-page":"1372","DOI":"10.2106\/00004623-198870090-00015","article-title":"Refracture of bones of the forearm after the removal of compression plates","volume":"70","author":"Deluca","year":"1988","journal-title":"J Bone Joint Surg Am."},{"issue":"2","key":"bib18-20250430","doi-asserted-by":"crossref","first-page":"294","DOI":"10.1016\/0363-5023(90)90112-5","article-title":"Forearm fracture plates: to remove or not to remove","volume":"15","author":"Labosky","year":"1990","journal-title":"J Hand Surg Am."},{"issue":"2","key":"bib19-20250430","doi-asserted-by":"crossref","first-page":"87","DOI":"10.1097\/00005131-199602000-00003","article-title":"Refracture risk after plate removal in the forearm","volume":"10","author":"Beaupre","year":"1996","journal-title":"J Orthop Trauma."},{"issue":"2","key":"bib22-20250430","doi-asserted-by":"crossref","first-page":"229","DOI":"10.1097\/01241398-199403000-00019","article-title":"The case against routine metal removal","volume":"14","author":"Kahle","year":"1994","journal-title":"J Pediatr Orthop."},{"issue":"2","key":"bib23-20250430","doi-asserted-by":"crossref","first-page":"140","DOI":"10.5435\/JAAOS-D-16-00102","article-title":"Current Trends in Ulnar Collateral Ligament Reconstruction Surgery Among Newly Trained Orthopaedic Surgeons","volume":"25","author":"Degen","year":"2017","journal-title":"J Am Acad Orthop Surg."},{"issue":"2","key":"bib24-20250430","doi-asserted-by":"crossref","first-page":"140","DOI":"10.5435\/JAAOS-D-16-00102","article-title":"Current Trends in Ulnar Collateral Ligament Reconstruction Surgery Among Newly Trained Orthopaedic Surgeons","volume":"25","author":"Degen","year":"2017","journal-title":"J Am Acad Orthop Surg."},{"issue":"12","key":"bib25-20250430","first-page":"e093","article-title":"Complications After Arthroscopic Shoulder Surgery: A Review of the American Board of Orthopaedic Surgery Database","volume":"2","author":"Shin","year":"2018","journal-title":"J Am Acad Orthop Surg Glob Res Rev."},{"issue":"5","key":"bib26-20250430","doi-asserted-by":"crossref","first-page":"e125","DOI":"10.1016\/j.jse.2015.11.065","article-title":"Frequency and complications after operative fixation of clavicular fractures","volume":"25","author":"Navarro","year":"2016","journal-title":"J Shoulder Elbow Surg."},{"issue":"2","key":"bib27-20250430","doi-asserted-by":"crossref","first-page":"292","DOI":"10.1177\/0363546513510677","article-title":"Complications after arthroscopic knee surgery","volume":"42","author":"Salzler","year":"2014","journal-title":"Am J Sports Med."},{"issue":"13","key":"bib28-20250430","doi-asserted-by":"crossref","first-page":"3174","DOI":"10.1177\/0363546518795690","article-title":"Surgical Volume and Postoperative Complications of Acromioclavicular Joint Separations: Analysis of the ABOS Part II Examination","volume":"46","author":"Hippensteel","year":"2018","journal-title":"Am J Sports Med."},{"issue":"10","key":"bib29-20250430","doi-asserted-by":"crossref","first-page":"2061","DOI":"10.1007\/s00264-016-3137-z","article-title":"Trends in primary and revision knee arthroplasty among orthopaedic surgeons who take the American Board of Orthopaedics part II exam","volume":"40","author":"Pour","year":"2016","journal-title":"Int Orthop."},{"issue":"11","key":"bib30-20250430","doi-asserted-by":"crossref","first-page":"3510","DOI":"10.1007\/s11999-014-3823-3","article-title":"High incidence of hemiarthroplasty for shoulder osteoarthritis among recently graduated orthopaedic surgeons","volume":"472","author":"Mann","year":"2014","journal-title":"Clin Orthop Relat Res."},{"issue":"10","key":"bib31-20250430","doi-asserted-by":"crossref","first-page":"2325967117730570","DOI":"10.1177\/2325967117730570","article-title":"Trends in Surgical Practices for Lateral Epicondylitis Among Newly Trained Orthopaedic Surgeons","volume":"5","author":"Wang","year":"2017","journal-title":"Orthop J Sports Med."},{"issue":"4","key":"bib32-20250430","doi-asserted-by":"crossref","first-page":"376","DOI":"10.1177\/1558944716668846","article-title":"Total Wrist Arthroplasty Versus Wrist Fusion: Utilization and Complication Rates as Reported by ABOS Part II Candidates","volume":"12","author":"Hinds","year":"2017","journal-title":"Hand (N Y)."},{"issue":"9","key":"bib33-20250430","doi-asserted-by":"crossref","first-page":"1363","DOI":"10.1016\/j.jse.2014.01.005","article-title":"Reverse total shoulder arthroplasty for the treatment of proximal humeral fractures: patterns of use among newly trained orthopedic surgeons","volume":"23","author":"Acevedo","year":"2014","journal-title":"J Shoulder Elbow Surg."},{"issue":"4","key":"bib34-20250430","doi-asserted-by":"crossref","first-page":"700","DOI":"10.2106\/JBJS.G.00517","article-title":"Nail or plate fixation of intertrochanteric hip fractures: changing pattern of practice. A review of the American Board of Orthopaedic Surgery Database","volume":"90","author":"Anglen","year":"2008","journal-title":"J Bone Joint Surg Am."},{"issue":"9","key":"bib35-20250430","doi-asserted-by":"crossref","first-page":"1855","DOI":"10.2106\/JBJS.G.01569","article-title":"Fractures of the distal part of the radius. The evolution of practice over time. Where\u2019s the evidence?","volume":"90","author":"Koval","year":"2008","journal-title":"J Bone Joint Surg Am."},{"issue":"13","key":"bib36-20250430","doi-asserted-by":"crossref","first-page":"e56","DOI":"10.2106\/JBJS.15.01478","article-title":"Trends in Bone-Block Augmentation Among Recently Trained Orthopaedic Surgeons Treating Anterior Shoulder Instability","volume":"98","author":"Degen","year":"2016","journal-title":"J Bone Joint Surg Am."},{"issue":"17","key":"bib37-20250430","doi-asserted-by":"crossref","first-page":"e71","DOI":"10.2106\/JBJS.15.01049","article-title":"Humeral Shaft Fracture Fixation: Incidence Rates and Complications as Reported by American Board of Orthopaedic Surgery Part II Candidates","volume":"98","author":"Gottschalk","year":"2016","journal-title":"J Bone Joint Surg Am."},{"issue":"14","key":"bib38-20250430","doi-asserted-by":"crossref","first-page":"1316","DOI":"10.2106\/JBJS.J.01756","article-title":"The benefits of implant removal from the foot and ankle","volume":"94","author":"Williams","year":"2012","journal-title":"J Bone Joint Surg Am."},{"issue":"5","key":"bib39-20250430","doi-asserted-by":"crossref","first-page":"846","DOI":"10.1097\/00005373-199611000-00013","article-title":"Routine implant removal after fracture surgery: a potentially reducible consumer of hospital resources in trauma units","volume":"41","author":"B\u00f6stman","year":"1996","journal-title":"J Trauma."},{"key":"bib40-20250430","doi-asserted-by":"crossref","first-page":"5250672","DOI":"10.1155\/2016\/5250672","article-title":"Is Hardware Removal Recommended after Ankle Fracture Repair?","volume":"2016","author":"Jung","year":"2016","journal-title":"Biomed Res Int."},{"issue":"5","key":"bib41-20250430","doi-asserted-by":"crossref","first-page":"716","DOI":"10.2106\/00004623-198668050-00011","article-title":"Orthopaedic operations in the United States, 1979 through 1983","volume":"68","author":"Rutkow","year":"1986","journal-title":"J Bone Joint Surg Am."},{"issue":"12","key":"bib42-20250430","doi-asserted-by":"crossref","first-page":"2705","DOI":"10.1016\/j.injury.2017.09.030","article-title":"Increased risk for complications following removal of hardware in patients with liver disease, pilon or pelvic fractures: A regression analysis","volume":"48","author":"Brown","year":"2017","journal-title":"Injury."},{"issue":"2","key":"bib43-20250430","first-page":"96","article-title":"Removal of metal implants after fracture surgery\u2014indications and complications","volume":"38","author":"Brown","year":"1993","journal-title":"J R Coll Surg Edinb."},{"issue":"423","key":"bib44-20250430","doi-asserted-by":"crossref","first-page":"222","DOI":"10.1097\/01.blo.0000130208.90879.67","article-title":"Femoral nail removal should be restricted in asymptomatic patients","author":"G\u00f6sling","year":"2004","journal-title":"Clin Orthop Relat Res."},{"key":"bib45-20250430","doi-asserted-by":"crossref","first-page":"418","DOI":"10.2174\/1874325001509010418","article-title":"High Rates of Postoperative Wound Infection Following Elective Implant Removal","volume":"9","author":"Backes","year":"2015","journal-title":"Open Orthop J."},{"key":"bib46-20250430","doi-asserted-by":"crossref","first-page":"147","DOI":"10.1186\/1471-2474-13-147","article-title":"Clinical outcome of implant removal after fracture healing. Design of a prospective multicentre clinical cohort study","volume":"13","author":"Vos","year":"2012","journal-title":"BMC Musculoskelet Disord."}],"container-title":["Journal of Bone and Joint Surgery"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.20.02231","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,8,26]],"date-time":"2026-08-26T13:36:27Z","timestamp":1787751387000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.2106\/JBJS.20.02231"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,8,16]]},"references-count":44,"journal-issue":{"issue":"22","published-print":{"date-parts":[[2021]]}},"URL":"https:\/\/doi.org\/10.2106\/jbjs.20.02231","relation":{},"ISSN":["0021-9355","1535-1386"],"issn-type":[{"value":"0021-9355","type":"print"},{"value":"1535-1386","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,8,16]]}}}