Implant Removal Matrix for the Foot and Ankle Orthopaedic Surgeon. Issue 1 (February 2019) - Kaiser, Philip B.
Background: Orthopaedic surgery frequently requires the use of metal plate and screw constructs for osteosynthesis. These constructs may be subsequently removed for a variety of indications. In the lower extremity in particular, implants (ie, hardware) can lead to prominence and pain secondary to a thin soft-tissue envelope with little subcutaneous tissue. Often, removal is performed without knowledge of the exact type of screw head configuration and/or size, which can make removal technically challenging. The purpose of this study is to consolidate screw head sizes and configurations from commonly utilized orthopaedic foot and ankle implant manufacturers matched against 2 commonly used universal implant removal sets to aid in the expeditious removal of hardware. Methods: Orthopaedic manufacturers of foot and ankle–specific implants were included based on market share. Publicly available information on screw size, head configuration, and driver size was collected and recorded. This information was cross-referenced against the drivers available in 2 commonly utilized universal implant removal sets. Results: Seven foot and ankle implant manufacturers were included. The data were compiled in table format according to manufacturer and subcategorized by noncannulated screws, cannulated screws, and locking screws. Conclusion: Many factors affect the success of hardware removal, and it is imperative that the surgeon knows which drivers are compatible with the implanted hardware. The expanding magnitude and diversity of orthopaedic implants makes removal of hardware more challenging. A guide of compatible drivers for various screw types helps expedite this procedure. Levels of Evidence: Level V