Do you remove a steel hip implant after Open Reduction Internal Fixation (ORIF) procedure?

Hardware Removal After Hip ORIF

Routine removal of hardware after ORIF of hip fractures is generally not necessary, and the decision should be based on specific clinical indications rather than routine practice.

When Hardware Should Be Removed

Hardware removal after hip ORIF is indicated only in specific circumstances:

• Symptomatic hardware causing pain, irritation, or mechanical problems 1
• Hardware failure with loss of fixation or breakage 2
• Infection requiring hardware removal as part of infection management 1
• Planned conversion to total hip arthroplasty (THA) for post-traumatic osteoarthritis, where hardware removal occurs during the THA procedure 1, 3

Approximately 24% of patients undergoing THA after acetabular ORIF required intra-operative hardware removal, with only one patient experiencing post-operative complications 1.

Evidence Against Routine Hardware Removal

The available evidence does not support routine hardware removal in asymptomatic patients:

• In a study of 61 patients with retained hardware after ORIF, 80.3% had no failure of fixation during follow-up, suggesting routine removal is unnecessary 2
• Only specific risk factors (older age correlating with lost reduction, elevated BMI correlating with hardware failure, and diabetes correlating with infection risk) predicted adverse outcomes with retained hardware 2
• Hardware can remain in place indefinitely if asymptomatic and not causing complications 2

Special Considerations for Acetabular Fractures

For acetabular fractures treated with ORIF, hardware removal becomes relevant primarily in the context of conversion to THA:

• Patients treated with ORIF alone have a 30% reoperation rate, often requiring conversion to THA within 2 years 3
• When post-traumatic osteoarthritis develops after acetabular ORIF, THA is frequently required, with mean time to conversion of 2.3 years 1
• During THA conversion, hardware removal is performed as needed for acetabular component placement 1, 4

Common Pitfalls to Avoid

• Do not routinely plan hardware removal in asymptomatic patients, as this exposes them to unnecessary surgical risk 2
• Do not delay THA conversion in elderly patients with post-traumatic arthritis after acetabular ORIF, as outcomes worsen with prolonged conservative management 3, 5
• Be aware that elderly patients with acetabular fractures have only 28.6% hip joint survival at 3 years with ORIF alone, compared to 100% with combined hip procedure (ORIF + acute THA) 5