{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,1]],"date-time":"2026-09-01T17:00:57Z","timestamp":1788282057287,"version":"build-2803163510"},"reference-count":28,"publisher":"MJS Publishing, Medical Journals Sweden AB","license":[{"start":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T00:00:00Z","timestamp":1769126400000},"content-version":"unspecified","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["ActaO"],"abstract":"<jats:p>Background and purpose:\u00a0While complication rates for primary pelvic and acetabular fracture surgeries are well documented, limited data exists on complications following osteosynthesis implant removals. We aimed to evaluate the complication rates of pelvic implant removals with respect to the surgical approach, type of implant, and indication for removal.Methods:\u00a0This retrospective, consecutive case series included all patients undergoing pelvic implant removal between January 2013 and December 2023 using Kocher-Langenbeck, modified Stoppa (AIP), or ilioinguinal approaches for the removal. Isolated minimally invasive, percutaneous implant removals were excluded.Results:\u00a0154 implant removals in 141 patients were analyzed. Overall complication rate was 34% (n = 53). Most common complications were intraoperative bleeding requiring transfusion (n = 17; 11%), postoperative anemia requiring transfusion (n = 12; 7.8%), and vascular injuries (n = 9; 5.8%). The ilioinguinal approach showed a higher complication rate (19\/37; 51%) than the Kocher-Langenbeck (21\/68; 31%) or the Stoppa\/AIP approach (13\/49; 27%). Removal of implants from the anterior pelvic ring and acetabulum (22\/45; 49%) also had a higher complication risk than from the posterior pelvic ring and acetabulum (20\/67; 30%) or of symphyseal plates (11\/42; 26%). Removal due to infection also showed a particularly high complication rate (25\/57; 44%) compared with aseptic indications, e.g., interfering material or removal for THA.Conclusion:\u00a0Pelvic implant removals, especially from the anterior pelvic ring or acetabulum, using the ilioinguinal approach, and in case of infection, are associated with a particularly high complication risk. These findings can support clinical decision-making and informing patients on the potential risks of hardware removals.<\/jats:p>","DOI":"10.2340\/17453674.2026.45294","type":"journal-article","created":{"date-parts":[[2026,1,23]],"date-time":"2026-01-23T15:53:54Z","timestamp":1769183634000},"source":"Crossref","is-referenced-by-count":1,"title":["Complication rates following open surgical removal of osteosynthesis material from the pelvis and acetabulum: a retrospective case series of 154 removals"],"prefix":"10.2340","volume":"97","author":[{"given":"Thore C","family":"Scherff","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Nico","family":"Hinz","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cornelius","family":"Grimme","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Karl-Heinz","family":"Frosch","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maximilian","family":"Hartel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1183","published-online":{"date-parts":[[2026,1,23]]},"reference":[{"key":"139522","doi-asserted-by":"crossref","unstructured":"K\u00fcper M A, Trulson A, Stuby F M, St\u00f6ckle U, Konrads C. Complications of surgical approaches for stabilization of pelvic ring injuries: analysis of pitfalls and how to avoid them. J Orthop 2020; 20: 261-7. doi: 10.1016\/j.jor.2020.05.002.","DOI":"10.1016\/j.jor.2020.05.002"},{"key":"139523","doi-asserted-by":"crossref","unstructured":"Mbatha S, Duma M, Maqungo S, Marais L. Complications of surgically managed pelvic and acetabular fractures. S Afr Orthop J 2023; 22(2): 68-74. doi: 10.17159\/2309-8309\/2023\/v22n2a1.","DOI":"10.17159\/2309-8309\/2023\/v22n2a1"},{"key":"139524","doi-asserted-by":"crossref","unstructured":"Kumar D, Singh S, Singh B, Singh A, Sriwastava A, Kumar A, et al. Intraoperative complications in acetabular fracture management using the Stoppa approach: a retrospective cohort study. Injury 2025; 56(3): 112208. doi: 10.1016\/j.injury.2025.112208.","DOI":"10.1016\/j.injury.2025.112208"},{"key":"139525","doi-asserted-by":"crossref","unstructured":"Hermans E, Biert J, Edwards M J R. Epidemiology of pelvic ring fractures in a Level 1 Trauma Center in the Netherlands. Hip Pelvis 2017; 29(4): 253-61. doi: 10.5371\/hp.2017.29.4.253.","DOI":"10.5371\/hp.2017.29.4.253"},{"key":"139526","doi-asserted-by":"crossref","unstructured":"Lundin N, Berg H E, Enocson A. Complications after surgical treatment of acetabular fractures: a 5-year follow-up of 229 patients. Eur J Orthop Surg Traumatol 2022; 33(4): 1245-53. doi: 10.1007\/s00590-022-03284-1.","DOI":"10.1007\/s00590-022-03284-1"},{"key":"139527","doi-asserted-by":"crossref","unstructured":"Lee H, Jo S, Lee G, Cho Y. Perioperative complications of the modified Stoppa approach for the treatment of pelvic bone fractures: a single-institution review of 48 cases. J Trauma Inj 2022; 35(1): 19-24. doi: 10.20408\/jti.2021.0061.","DOI":"10.20408\/jti.2021.0061"},{"key":"139528","doi-asserted-by":"crossref","unstructured":"Busam M L, Esther R J, Obremskey W T. Hardware removal: indications and expectations. J Am Acad Orthop Surg 2006; 14(2): 113-20. doi: 10.5435\/00124635-200602000-00006.","DOI":"10.5435\/00124635-200602000-00006"},{"key":"139529","unstructured":"Cronin P, Watkins I, Riedel M, Kaiser P, Kwon J. Implant removal matrix for the upper extremity orthopedic surgeon. Arch Bone Jt Surg 2020; 8(1): 99-111. doi: 10.22038\/abjs.2019.36525.1962."},{"key":"139530","doi-asserted-by":"crossref","unstructured":"Quade J, Busel G, Beebe M, Auston D, Shah AR, Infante A, et al. Symptomatic iliosacral screw removal after pelvic trauma: incidence and clinical impact. J Orthop Trauma 2019; 33(7): 351-3. doi: 10.1097\/BOT.0000000000001453.","DOI":"10.1097\/BOT.0000000000001453"},{"key":"139531","doi-asserted-by":"crossref","unstructured":"M\u00fcller-F\u00e4rber J. [Removal of metal in traumatology]. Unfallchirurg 2003; 106(8): 653-70. doi: 10.1007\/s00113-003-0637-2.","DOI":"10.1007\/s00113-003-0637-2"},{"key":"139532","unstructured":"AWMF. 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Intraoperative red blood cell transfusion decision-making: a systematic review of guidelines. Ann Surg 2021; 274(1): 86-96. doi: 10.1097\/SLA.0000000000004710.","DOI":"10.1097\/SLA.0000000000004710"},{"key":"139536","doi-asserted-by":"crossref","unstructured":"Meier J, Filipescu D, Kozek-Langenecker S, Llau Pitarch J, Mallett S, Martus P, et al. Intraoperative transfusion practices in Europe. Br J Anaesth 2016; 116(2): 255-61. doi: 10.1093\/bja\/aev456.","DOI":"10.1093\/bja\/aev456"},{"key":"139537","doi-asserted-by":"crossref","unstructured":"Lenet T, McIsaac D I, Hallet J H, Jerath A, Lalu M M, Nicholls S G, et al. Intraoperative blood management strategies for patients undergoing noncardiac surgery: the Ottawa Intraoperative Transfusion Consensus. 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