Understand indications for retained hardware removal in TKA without forcing malposition
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Surgeons should understand the stages and indications for removal of retained hardware in total knee arthroplasty to avoid malpositioning, infection or the unnecessary removal of hardware, according to a presenter.
“Retained hardware can be present for a lot of reasons: post-traumatic problems, post-osteotomy problems, post-ligament reconstruction [and] post-tibial tubercle work,” Daniel J. Berry, MD, said in his presentation at the Current Concepts in Joint Replacement Meeting. “You recognize the main problems it can cause. Implant malposition is the big one. If you take it out, it can also cause infection or it can be associated with infection. But also remember, that as you take out implants or metal, you can have complications of the removal of that metal: wound problems [and] bone fracture problems,” he added.
There are three options for addressing retained hardware in TKA, according to Berry. Retained hardware can be removed in a one-stage process, in which the surgeon removes hardware during the TKA procedure. Retained hardware can also be removed in a separate procedure before TKA. Surgeons may also simply leave the hardware in place and work around it, he said.
Two-stage removal should be performed when there is a concern for infection or previous infection, Berry said. It is also indicated for removal of hardware that will require a complex incision and may not be feasible during a TKA procedure, he added.
Indications for one-stage removal include hardware that is in the way and would block placement of the implant, or hardware that is symptomatic for the patient, Berry said. He stressed that surgeons should only remove necessary hardware in order to avoid lengthy procedures, which increase the risk of infections and complications. Berry suggested using a wet, spongy towel and sterile ultrasound gel to cover the wound during removal of hardware to reduce the risk of infection from metal shavings.
“Don’t let hardware force you into malposition,” Berry concluded. “Two-stage removal of the hardware is generally indicated for infection concerns and other situations. Otherwise, when you are taking out a ‘one-stage,’ only take out the metal you have to,” he added.
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Berry DJ, et al. The knee with retained hardware from previous procedure. Presented at: Current Concepts in Joint Replacement Meeting; Dec. 7-10, 2022; Orlando (hybrid meeting).
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