When can an implant be removed?

When Can an Implant Be Removed?

The timing and indications for implant removal depend critically on the implant type, with phakic intraocular lenses requiring removal when endothelial cell loss exceeds 20% or cell count drops below 1500 cells/mm², orthopedic implants removed primarily for symptomatic indications after fracture healing, contraceptive implants by 3 years, and dental implants when biological or esthetic complications cannot be predictably managed. 1, 2, 3, 4

Phakic Intraocular Lenses (PIOLs)

Monitoring Protocol

• Perform specular microscopy preoperatively and at 6,12,24, and 36 months postoperatively at minimum 1
• Obtain minimum 6 scans preoperatively and 3 scans at each postoperative visit 1

Removal Triggers

• 20% endothelial cell loss from preoperative density triggers immediate retesting to confirm 1
• Endothelial cell count <1500 cells/mm² requires recall and confirmatory testing 1
• Accelerated annual cell loss rate >1%/year on serial microscopy every 4-6 months warrants consideration for removal 1
• The American Academy of Ophthalmology emphasizes that removal should occur before irreversible corneal edema develops 1

Orthopedic/Fracture Fixation Implants

Primary Indications for Removal

• Pain, discomfort, or prominent hardware is the most common indication (mechanical symptoms) 4, 5
• Infection is the second most common reason and represents a true medical indication 4, 5
• Implant failure including hardware breakage or loosening 4
• Intra-articular material represents a true medical indication requiring removal 5

Timing Considerations

• Remove only after fracture healing is complete 6, 5
• Avoid routine removal in asymptomatic patients, as some develop new complaints post-removal 5
• The decision should be patient-driven for relative indications, with thorough informed consent about risks 5

Fracture-Related Infection (FRI) Specific Timing

• Within 3 weeks of fracture fixation: Debridement, antibiotics, and implant retention (DAIR) achieves 90%+ success 1
• Up to 6 weeks post-fixation: DAIR success rates around 70% 1
• Beyond 10 weeks: DAIR success drops to 51-67% due to mature biofilm formation 1
• After biofilm maturation: Complete implant removal becomes necessary as antibiotics cannot eradicate infection regardless of duration 1

Contraceptive Implants (Nexplanon)

Mandatory Removal Timeline

• Remove by the end of the third year of use 2
• Fertility returns rapidly after removal 2
• Removal is an office-based procedure requiring trained providers 2

Dental Implants

Indications for Removal

• Esthetic complications that cannot be predictably managed to satisfy patient demands 3
• Biological complications (peri-implantitis, bone loss) refractory to treatment 3
• Prosthetic complications that cannot be resolved with the existing implant 3

Removal Technique

• Use minimally invasive reverse torque engineering methods to preserve peri-implant tissues 3
• Implant replacement at previously failed sites shows high survival rates when properly planned 3

Maxillary Sinus Implant Migration

Removal Indications

• Lack of osseointegration with membrane perforation and force pushing implant toward sinus 1
• Symptomatic sinusitis or oroantral communication 1
• Can be asymptomatic but still require removal 1

Removal Approach

• Intra-oral approach (modified Caldwell-Luc) is preferred when possible, as it preserves intranasal anatomy 1
• Functional endoscopic sinus surgery may be needed for inaccessible implants but alters anatomy 1
• Most patients recover completely with appropriate surgical approach 1

Cancer-Related Device Infections

General Principle

• Removal or replacement often necessary when systemic antimicrobials fail due to biofilm formation 1
• Removal may be difficult or prohibitive due to thrombocytopenia, immunosuppression, lack of vascular access, or prior surgeries 1
• Decision balances infection control against procedural risks in immunocompromised patients 1

Critical Pitfalls to Avoid

• Don't remove asymptomatic orthopedic implants routinely—this practice has declined and can cause new problems 6, 5
• Don't delay PIOL removal once endothelial cell thresholds are crossed—irreversible corneal damage may occur 1
• Don't attempt implant retention in FRI beyond 10 weeks without understanding the declining success rates from mature biofilm 1
• Don't underestimate removal difficulty—bone ingrowth and implant wear can make removal more challenging than initial placement 4