Our experience regarding indications benefits complications in 200 cases with summarizing various techniques for orthopaedics implant removal

PurposeElective implant removal (IR) in the upper extremity remains controversial. Implants in the olecranon and clavicle are commonly removed for prominence, unlike in the distal radius. Patient-reported symptomatic cannot be verified, and nonspecific discomfort remains unquantified. In this study, indications and outcomes of IR at the clavicle, olecranon and distal radius were evaluated, with a focus on postoperative patient satisfaction.Materials and methodsIn this retrospective, single-center cohort study, patients, who received elective IR of the clavicle, olecranon and distal radius were included. Patients were followed up at least six weeks after IR. Outcomes included patient satisfaction, symptom resolution, and complications.ResultsOne hundred and eighty-nine patients were included. Unspecific symptoms of discomfort were the most prevalent indication for IR (48.7%), followed by pain (29.6%) and objective limited range of motion (ROM) (7%). Pain and limited ROM combined was observed in 13.8%. Subjective benefit following IR was described in 54%. Patients with limited ROM (OR 4.7, p < 0.001) or pain (OR 4.1, p < 0.001) were more likely to experience alleviation of complaints. Patients with unspecific symptoms of discomfort, often did not report improvement. Major complications occurred in 2%. Refractures were detected at the clavicle (3.7%) and at the olecranon (2.5%). Minor complication rate was 5%.ConclusionIR is a safe procedure in the upper extremity. Indications based on unspecific symptoms of discomfort have a significant lower rate of patient satisfaction postoperatively. Elective IR should be considered cautiously, if it is driven primarily by unspecific symptoms of discomfort. Patient education is relevant to prevent dissatisfying outcome.

Metallic artifact in MRI after removal of orthopedic implants

Retrospective cohort study using prospectively collected registry data. The purpose of this study is to evaluate health-related quality of life (HRQOL) and postoperative satisfaction in patients with different histotypes of benign extramedullary spinal tumors (ESTs). Little is known about how different histotypes influence HRQOL and postoperative satisfaction in EST patients. Patients undergoing primary benign EST surgery at 11 tertiary referral hospitals between 2017 and 2021 who completed preoperative and 1-year postoperative questionnaires were included. HRQOL assessment included the Physical Component Summary and Mental Component Summary (MCS) of Short Form-12, EuroQol 5-dimension, Oswestry/Neck Disability Index (ODI/NDI), and Numeric Rating Scales (NRS) for upper/lower extremities (UEP/LEP) and back pain (BP). Patients who answered "very satisfied," "satisfied," or "somewhat satisfied" on a seven-point Likert scale were considered to be satisfied with treatment. Student t -tests or Welch's t -test were used to compare continuous variables between two groups, and one-way analysis of variance was used to compare outcomes between the three groups of EST histotypes (schwannoma, meningioma, atypical). Categorical variables were compared using the χ 2 test or Fisher exact test. A total of 140 consecutive EST patients were evaluated; 100 (72%) had schwannomas, 30 (21%) had meningiomas, and 10 (7%) had other ESTs. Baseline Physical Component Summary was significantly worse in patients with meningiomas ( P =0.04), and baseline NRS-LEP was significantly worse in patients with schwannomas ( P =0.03). However, there were no significant differences in overall postoperative HRQOL or patient satisfaction between histology types. Overall, 121 (86%) patients were satisfied with surgery. In a subgroup analysis comparing intradural schwannomas and meningiomas adjusted for patient demographics and tumor location with inverse probability weighting, schwannoma patients had worse baseline MCS ( P =0.03), ODI ( P =0.03), NRS-BP ( P <.001), and NRS-LEP ( P =0.001). Schwannoma patients also had worse postoperative MCS ( P =0.03) and NRS-BP ( P =0.001), with no significant difference in the percentage of satisfied patients ( P =0.30). Patients who underwent primary benign EST resection had a significant improvement in HRQOL postoperatively, and ~90% of these patients reported being satisfied with their treatment outcomes one year after surgery. EST patients may exhibit a relatively lower threshold for postoperative satisfaction compared with patients undergoing surgery for degenerative spine conditions.

A cross-sectional study was designed to shed light on the clinical sequelae and patient satisfaction after dental implant removal (IR). Patients undergoing ≥1 IRs were eligible. The reasons for implant failure, clinical and radiological parameters before and after IR, and the surgical and prosthetic treatments offered after IR was assessed. Patient satisfaction was recorded and the Oral Health Impact Profile (OHIP)-14 was used to document patient self-reported dysfunction and discomfort attributed to IR. Lastly, patient expectations after IR were also evaluated. Thirty-one patients with 45 implants were analyzed. Peri-implantitis was the main reason for IR (64.5%). The average implant survival time before IR was 120.3 ± 88.2 months. Signs of infection (51.7%) and bleeding on probing (37.5%) were common signs detected at the time of IR. Guided bone regeneration was the intervention most commonly applied simultaneously to IR (74.1%). The reported degree of satisfaction was high, and the overall OHIP-14 score was low. However, a certain patient reluctance to undergo future implant placement in the same clinic or with the same professional was recorded, and a statistically significant increase in adherence to the implant maintenance routine was observed after IR. Peri-implantitis is the leading cause for IR. Guided bone regeneration is commonly applied to attenuate the clinical sequelae of IR. Nonetheless, IR does not seem to affect patients' satisfaction nor their quality of life, though a certain patient reluctance to undergo future implant placement in the same clinic or with the same professional was reported.

PurposeThe topic of elective implant removal (IR) in healed fractures of the lower extremity remains controversial, particularly when unspecific symptoms of discomfort, which cannot be quantified, are the primary indication. This study aims to assess indications and outcomes of elective IR of the lower extremity, focusing on unspecific symptoms of discomfort and patient satisfaction postoperatively.Materials and methodsThe retrospective cohort study was conducted at a single level I academic trauma center. We included patients who underwent elective IR for healed fractures of the ankle, foot, patella, and proximal tibia from 2016 to 2021. All patients were followed-up for a minimum of 6 weeks after IR. Our outcomes of interest were patient satisfaction, complications, and alleviation of complaints.Results A total of 167 patients were included in the study. Unspecific symptoms of discomfort were the most common reason for IR in all investigated anatomical regions of the lower extremity (47.9%), followed by pain (43.1%) and limited range of motion (4.2%). 4.8% of patients experienced a combination of pain and range of motion limitation. Among all patients, 47.9% reported subjective improvement after IR. IRs based on unspecific symptoms of discomfort were significantly less likely to show alleviation of complaints after IR (27.5%, OR 0.19, p ≤ 0.01). Patients who reported limited range of motion (OR 1.7, p = 0.41) or pain (OR 6.0, p = 0) were significantly more likely to be satisfied after IR. Patients who reported sensitivity to cold weather also showed a decrease of complaints after IR (OR 3.6, p = 0.03). Major complications occurred in 2.1% of cases. The minor complication rate was 8.4% (predominantly impaired wound healing). Smoking patients showed a significantly higher risk of complications after IR (OR 5.2, p = 0.006). Persistent pain postoperatively was detected in 14.7%.ConclusionWhen elective IR for consolidated fractures of the lower extremity is primarily motivated by patients’ subjective symptoms of discomfort, the risk for postoperative dissatisfaction significantly increases. Objective symptoms on the other hand are associated with higher satisfaction after IR. While the procedure is generally safe, minor complications such as wound healing disorders can occur, especially in smokers. Patient education and well-documented informed consent are critical.

PURPOSE: Current evidence has not linked breast implants to autoimmune or other systemic diseases; however, women continue to pursue explantation due to a heterogenous constellation of symptoms referred to as “breast implant illness” (BII). Although BII has no clear medical definition, pathophysiological explanation or diagnostic testing, a subset of patients report symptomatic improvement after explantation. Although several studies have attempted to clarify and better define this phenomenon, none have considered patient satisfaction and quality of life following implant removal. This study aims to assess patient reported satisfaction with the removal of implants through the use of the BREAST-Q. METHODS: Patients who underwent breast implant removal due to concerns for BII were asked to complete the augmentation BREAST-Q. Additionally, a survey was administered that queried 35 different BII-related symptoms and their response to implant removal. Questions specifically referencing the implants were removed because they were not applicable to this cohort. Consistent with scoring guidelines, missing data were replaced with the mean of remaining scores as long as 50% of questions were still completed. Outcomes in this cohort were compared with normative data for all modules this information was available for. Furthermore, satisfaction for patients who underwent explantation alone was compared with those who pursued explantation with cosmetic reconstruction. RESULTS: Of the 29 patients who underwent implant removal for BII, 16 patients (55.2%) completed the BREAST-Q and symptom survey. Mean age was 49.1 ± 10.8, and mean BMI was 25.1 ± 8. Interestingly, all patients were Whites. En bloc capsulectomy was requested by patients and performed in 100% of cases. The average time between augmentation and implant removal was 11.3 ± 6.2 months. Only 11 patients (68.8%) underwent implant removal and the other five underwent a cosmetic procedure (either autologous reconstruction or mastopexy) in addition to implant removal. Subjects report on average a total of 13.1 symptoms with brain fog, fatigue, chest discomfort, and anxiety being the most common. On average, symptoms of 14.9% of patients did not improve, those of 48.1% partially improved, and those of 37.0% were completely resolved. Compared with normative data, BII patients with implant removal alone had scores comparable to those of normative BREAST-Q data in the psychosocial well-being (P = 0.928), sexual well-being (P = 0.819), and satisfaction with breast modules (P = 0.529). They had lower scores for physical well-being (17 versus 86, P < 0.001). Upon subgroup analysis, implant removal with cosmetic procedures had a higher score in the satisfaction with breast module when compared with implant removal alone (76 versus 48, P = 0.022), though no other differences were seen. CONCLUSIONS: Concurrent with previous literature, patients with BII report some degree of symptomatic improvement after removal of implants. Patient-reported outcomes are similar to normative data in recently augmented patients. However, despite reported improvement of symptoms, physical well-being remains lower for patients with breast implant illness even after implant removal. Implant removal may be combined with cosmetic procedures to improve satisfaction with breasts. These results may aid in preoperative patient counseling.

Racial disparities in bariatric surgery postoperative weight loss and patient satisfaction

Retrospective review of cohort studies. To analyze how different ODI subsections and their improvement affect patient satisfaction 2 years after elective lumbar surgery for degenerative lumbar spondylolisthesis (DLS). The Oswestry Disability Index (ODI) is crucial in evaluating outcomes of spinal disorders and provides valuable insights into a patient's preoperative status. There is limited information available on the individual characteristics of its subsections and their relation to postoperative patient satisfaction. Pre- and 2-year postoperative ODI and patient satisfaction were assessed. The analysis included preoperative scores and improvements in each ODI subsection 2 years postoperatively. Satisfaction was rated on a scale of 1 to 5, with scores ≥4 deemed satisfactory. Univariate linear regression and ROC analysis established cutoffs for subsection improvement and postoperative target values to achieve postoperative satisfaction. Two hundred sisty-five patients (60% female, 67±8y) were included. ODI improvement was achieved in 91%, and postoperative patient satisfaction in 73%. Patients with lower postoperative subsection scores and greater differences between pre- and postoperative scores were more likely to be satisfied (all P <0.001). A postoperative subsection target score of ≤1 was associated with patient satisfaction. Change in degree of pain was the most predictive subsection for satisfaction, with an AUC of 0.84 (sensitivity 79%, specificity 86%). Walking (AUC 0.83, sensitivity 87%, specificity 65%), pain intensity (AUC 0.82, sensitivity 79%, specificity 79%), personal care (AUC 0.82, sensitivity 83%, specificity 68%), and standing (AUC 0.82, sensitivity 83%, specificity 83%) all had an AUC greater than 0.80. The postoperative subsection with the lowest predictability was sleeping (AUC 0.69). Pain domains, walking, standing, and personal care were the subsections with the highest predictability for patient satisfaction. These findings on the correlation between different ODI subscales and patient satisfaction are valuable for improving preoperative education, addressing disability, and ensuring postoperative satisfaction.

Orthopedic Implant removal is one of the commonly performed elective orthopedic surgeries. Implants are generally removed after the purpose of keeping implant is solved by healing of the fracture, but there is no consensus whether routine implant removal should be a policy for all fractures that were fixed. This study aims to analyze the epidemiology and outcome of implant removal surgery carried out in the past three years in Kathmandu University Hospital. Patients who underwent implant removal between 2010 January to 2012 December constituted the study cohort. Demographic data, indications, types of hardware and location of fractures were recorded. Similarly, duration of surgery, type of anesthesia and duration of hospital stay were recorded. All the patients who had undergone implant removal in this three years period were called for follow up examination but those who were not able to come were interviewed on telephone. There were 275 implant removals constituting 7.8% of total orthopedic operations and 26.3% of fracture fixations. Male to Female ratio was 189: 86. Pediatric age group (34.5%) had the highest incidence of implant removal. Moderate sized implants were the commonest hardwares removed (63.2%). Femur (27.3%) followed by radius (26.9%) were the commonest bone for implant removal. Average operative time was 47.3 minutes with average hospital inpatient stay of 2.6 days. Commonest indication for the implant removal procedure was pain (45%). Implant removal procedures are one of the most commonly performed elective orthopedic surgeries. Though, after orthopedic implants removal, pain relief can be expected but it is not so predictive and hence patient should be well counseled before and the indications for implant removal has to be evaluated for better patient satisfaction and safety.

Context:There are no reports of patient satisfaction with implant removal after stabilization using percutaneous pedicle screws (PPS) for traumatic thoracolumbar fracture (TTF).Aims:The aim of this study was to investigate patient satisfaction with implant removal after stabilization using PPS for TTF.Settings and Design:A retrospective study.Subjects and Methods:The present study included data from 24 patients who underwent posterior stabilization using PPS for single-level TTF following implant removal. The degree of patient satisfaction was evaluated using a questionnaire. We investigated residuary back pain, using the numerical rating scale (NRS) and Oswestry disability index (ODI), and types of occupation. Patients were divided into groups of those with residuary back pain (Group P) and those without (Group N). We evaluated local kyphosis and disc degeneration after implant removal. We investigated whether residuary back pain or types of occupation affect patient satisfaction.Statistical Analysis Used:All statistical analyses were conducted using IBM SPSS statistics.Results:Patients were “extremely satisfied” in 13 cases (54%), “moderately satisfied” in eight cases (33%), and “neither” in three cases (13%). No patients answered “moderately dissatisfied” or “extremely dissatisfied.” The mean scores on the NRS and ODI in Group P were 1.8 ± 0.9 and 13.2 ± 9.3, respectively. Patient satisfaction, disc degeneration, and local kyphosis were not significantly different between Group P and Group N. Patient satisfaction was not significantly different between the hard and light workgroups.Conclusions:Patient satisfaction with implant removal was high regardless of whether persistent back pain existed and did not depend on the type of occupation.

Following clean (class I, not contaminated) surgical procedures, the rate of surgical site infection (SSI) should be less than approximately 2%. However, an infection rate of 12.2% has been reported following removal of orthopedic implants used for treatment of fractures below the knee. To evaluate the effect of a single dose of preoperative antibiotic prophylaxis on the incidence of SSIs following removal of orthopedic implants used for treatment of fractures below the knee. Multicenter, double-blind, randomized clinical trial including 500 patients aged 18 to 75 years with previous surgical treatment for fractures below the knee who were undergoing removal of orthopedic implants from 19 hospitals (17 teaching and 2 academic) in the Netherlands (November 2014-September 2016), with a follow-up of 6 months (final follow-up, March 28, 2017). Exclusion criteria were an active infection or fistula, antibiotic treatment, reimplantation of osteosynthesis material in the same session, allergy for cephalosporins, known kidney disease, immunosuppressant use, or pregnancy. A single preoperative intravenous dose of 1000 mg of cefazolin (cefazolin group, n = 228) or sodium chloride (0.9%; saline group, n = 242). Primary outcome was SSI within 30 days as measured by the criteria from the US Centers for Disease Control and Prevention. Secondary outcome measures were functional outcome, health-related quality of life, and patient satisfaction. Among 477 randomized patients (mean age, 44 years [SD, 15]; women, 274 [57%]; median time from orthopedic implant placement, 11 months [interquartile range, 7-16]), 470 patients completed the study. Sixty-six patients developed an SSI (14.0%): 30 patients (13.2%) in the cefazolin group vs 36 in the saline group (14.9%) (absolute risk difference, -1.7 [95% CI, -8.0 to 4.6], P = .60). Among patients undergoing surgery for removal of orthopedic implants used for treatment of fractures below the knee, a single preoperative dose of intravenous cefazolin compared with saline did not reduce the risk of surgical site infection within 30 days following implant removal. clinicaltrials.gov Identifier: NCT02225821.

IntroductionStunning recent increases in subdermal contraceptive implant use, especially in sub-Saharan Africa, necessitate availability of quality implant removal services. In Nigeria, service delivery capacity and coverage for removal are lacking, despite strong government commitment and rapid uptake; there is a dearth of knowledge about barriers to quality implant removals in Nigeria.MethodsTo determine access to and quality of contraceptive implant removal services, a landscape assessment was conducted in two states in Nigeria, focusing on four conditions for quality delineated in the Global Implant Removals Task Force framework. This mixed-methods approach integrated results from a desk review, a survey of health facilities and family planning managers, review of implant service statistics, and key informant interviews with providers and diverse stakeholders.ResultsSeventy percent of providers (N = 21 of 30) had experienced problems performing implant removal, usually due to deeply inserted implants and equipment shortages. Providers had low confidence in performing removal and poor knowledge of implant removal steps. No facilities assessed had comprehensive equipment required for implant removal. Few facilities maintained systems or referral pathways to support difficult removals; difficult removals are absent from training manuals, and no formal trainings have been conducted. While most facilities collect data on removals, family planning dashboards do not capture it; few facilities use data for quality improvement.ConclusionThis study identified numerous challenges to quality implant removal, including poorly trained providers, inadequate supplies, underutilization of data on removals, and inability to manage difficult removals. As demand for implant removals skyrockets, providers need improved training in implant removal, appropriate job aids, supportive supervision, and effective procurement systems to ensure availability of supplies and equipment for removal. Tracking removals and reasons for removal in information systems and the Family Planning dashboard could sensitize providers to need for implant removals and improve data for decision-making in facilities and health systems.

Background: Orthopaedic surgeries require sensitive protocol for prevention of infection pre and post-surgery. Antibiotic-prophylaxis has been reported for reducing risk of infection in orthopaedic surgeries such as removal of implants. Aim: To assess the effect of prophylactic antibiotics in orthopaedic surgery. Study design: Retrospective study Place and duration of study: Dept. of Orthopaedics, Khyber Teaching Hospital, Peshawar from 1-1-2020 to 31-12- 2020. Methodology: One hundred and ten patients within 18-75 years were divided into two groups. Each group had 55 patients. Group 1 were given prophylactic antibiotics pre-operative as a single dose while group 2 were given only saline. All patients were admitted for removal of orthopaedic implants in foot, ankle or leg. Patients 30 days record was observed for any surgical-site infection. Results: The mean age of patient was 42.95±10.8 years. Group 1 and Group 2 had more males than females. There were 10.9% and 9.09% diabetic patients within group 1 and group 2. The 30 days assessment of post implant removal orthopaedic surgery showed a decrease of surgical-site infection in group 1. Surgical-site infection decreased by a rate of 5.4% among patients who were given cefazolin antibiotic. Conclusion: The effect of prophylactic antibiotic reduces chance of surgical-site infection in orthopaedic surgery. Keywords: Antibiotic-prophylaxis, Orthopaedic surgery, Implant-removal, Surgical-site infection

To evaluate the available literature for postoperative fracture rates following implant removal in the pediatric population. A systematic review of articles in the PubMed and Embase computerized literature databases from January 2000 to June 2022 was performed using PRISMA guidelines. Randomized controlled trials, case-control studies, cohort studies (retrospective and prospective), and case series involving pediatric patients that included data on fracture rate following removal of orthopedic implants were eligible for review. Two authors independently extracted data from selected studies for predefined data fields for implant type, anatomic location of the implant, indication for implantation, fracture or refracture rate following implant removal, mean time to implant removal, and mean follow-up time. Fifteen studies were included for qualitative synthesis. Reported fracture rates following implant removal vary based on several factors, with an overall reported incidence of 0%-14.9%. The available literature did not offer sufficient data for conduction of a meta-analysis. Our systematic review demonstrates that fracture following implant removal in pediatric patients is a relatively frequent complication. In children, the forearm and femur are the most commonly reported sites of fracture following removal of implants. Traumatic fractures treated definitively with external fixation have the highest reported aggregate rate of refracture. Knowledge of the incidence of this risk is important for orthopedic surgeons. There remains a need for well-designed studies and trials to further clarify the roles of the variables that contribute to this complication.

Objective To explore the effects of psychological nursing on treatment in anterior tooth injury young patients with fiber splint fixing. Methods From September 2016 to September 2019, this study selected 110 anterior tooth injury young patients with fiber splint fixing in Emergency Comprehensive Treatment Center at Beijing Stomatological Hospital as subjects by convenience sampling. All of patients were randomly divided into routine nursing group (n=58) and psychological nursing group (n=52) . Routine nursing group carried out the routine nursing. On the basis of that in routine nursing group, psychological nursing group implemented psychological nursing. Patients of two groups were investigated with the Self-Rating Anxiety Scale (SAS) to explore the anxiety of patients with different nursing interventions; and the postoperative satisfaction and compliance of patients were compared between two groups. Results The scores of SAS in psychological nursing group were lower than those in routine nursing group 2 and 4 weeks after surgery with statistical differences (P 0.05) . The postoperative satisfaction of patients in psychological nursing group was higher than that in routine nursing group with a statistical difference (P 0.05) . The compliance of brushing their teeth as required and without biting hard object among patients in psychological nursing group were higher than those in routine nursing group with statistical differences (P<0.05) . Conclusions Psychological nursing can reduce anxiety in anterior tooth injury young patients with fiber splint fixing, which also improve patients satisfaction and postoperative compliance, and has a positive role in treatment. Key words: Young adult; Psychological nursing; Teeth injury; Fiber splint fixing