The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Implant Removal Due to Infection After Open Reduction and Internal Fixation: Trends and Predictors

Document Type : RESEARCH PAPER

Authors
Alec S. Kellish 1
Alisina Shahi 2
Julio A. Rodriguez Jr. 1
Kudret Usmani 2
Michael Boniello 2
Ali Oliashirazi 3
Graf Keneth 2
Henry Dolch 2
David Fuller 2
Rakesh Mashru 2
1 Cooper Medical School of Rowan University, Camden, New Jersey, USA
2 Department of Orthopaedic Surgery, Cooper University Hospital, Camden, New Jersey, USA
3 Oliashirazi Institute at Marshall University, Huntington, West Virginia, USA
10.22038/abjs.2021.53838.2688
Abstract
Background: Implant removal due to infection is one of the major causes failure following open reduction and internal 
fixation (ORIF). The aim of this study was to determine trends and predictors of infection-related implant removal 
following ORIF of extremities using a nationally representative database.
Methods: Nationwide Inpatient Sample data from 2006 to 2017 was used to identify cases of ORIF following upper and 
lower extremity fractures, as well as cases that underwent infection-related implant removal following ORIF. Multivariate 
analysis was performed to identify independent predictors of infection-related implant removal, controlling for patient 
demographics and comorbidities, hospital characteristics, site of fracture, and year. 
Results: For all ORIF procedures, the highest rate of implant removal due to infection was the phalanges/hand (5.61%), 
phalanges/foot (5.08%), and the radius/ulna (4.85%). Implant removal rates due to infection decreased in all fractures 
except radial/ulnar fractures. Tarsal/metatarsal fractures (odds ratio (OR)=1.45, 95% confidence interval (CI): 1.02-
2.05), and tibial fractures (OR=1.82, 95% CI: 1.45-2.28) were identified as independent predictors of infection-related 
implant removal. Male gender (OR=1.67, 95% CI: 1.49-1.87), Obesity (OR=1.85, 95% CI: 1.34-2.54), diabetes mellitus 
with chronic complications (OR=1.69, 95% CI: 1.13-2.54, P<0.05), deficiency anemia (OR=1.59, 95% CI: 1.14-2.22) 
were patient factors that were associated with increased infection-related removals. Removal of implant due to infection 
had a higher total charge associated with the episode of care (mean: $166,041) than non-infection related implant 
removal (mean: $133,110).
Conclusion: Implant removal rates due to infection decreased in all fractures except radial/ulnar fractures. Diabetes, 
liver disease, and rheumatoid arthritis were important predictors of infection-related implant removal. The study 
identified some risk factors for implant related infection following ORIF, such as diabetes, obesity, and anemia, that 
should be studied further to implement strategies to reduce rate of infection following ORIF.
Level of evidence: III
Keywords
Fracture
Implant removal
Infection-related implant removal
Infection
Septic hardware
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The Archives of Bone and Joint Surgery
Volume 10, Issue 6
June 2022
Pages 514-524

  • Receive Date 27 November 2020
  • Revise Date 23 October 2021
  • Accept Date 25 October 2021