The Archives of Bone and Joint Surgery

The Archives of Bone and Joint Surgery

Evaluation of Implant Removal Difficulty in Distal Femur Fractures: A Comparison between Stainless Steel and Titanium Locking Compression Plate

Document Type : RESEARCH PAPER

Authors
Hamed Tayyebi 1
Nicholas Frane 2
Victoria Greenstein 1
Arjun Arjun Vohra 1
Clayton Hui 1
Michael McKee 1
Niloofar Dehghan 3
1 University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA
2 HealthPartners Orthopedics, Minneapolis, MN, USA
3 University of Arizona College of Medicine-Phoenix, Phoenix, AZ, USA- The CORE Institute, Phoenix, AZ, USA
10.22038/abjs.2025.84756.3858
Abstract
Objectives: Objectives: Titanium plates may offer advantages in fracture healing, yet concerns remain regarding hardware removal due to risks such as screw stripping and cold welding. Whether titanium removal is more difficult than stainless steel remains uncertain. This study compared the ease of implant removal, focusing on distal femur fractures treated with titanium versus stainless-steel plates.
Methods: We conducted a retrospective cohort study of patients with distal femur fractures who underwent implant removal after fixation with either stainless-steel or titanium plates. The primary outcome was difficulty of removal, including cold welding, screw stripping, hardware breakage, and use of advanced tools (screw removal set, trephine, burr). The secondary outcome was operative duration.
Results: Seventy-two patients were included: 31 stainless steel and 41 titanium. Mean in-vivo implant time was 421 ± 498 days for stainless steel and 360 ± 409 days for titanium (P = 0.57). Difficulties with removal occurred in 13% of stainless-steel cases and 12% of titanium cases (P = 0.92). Screw removal sets were required in 9.7% and 9.8% of patients, respectively (P = 0.99). Advanced extraction tools were used in 3 patients per group (P = 0.72). Cold-welded or stripped screws occurred in 2 patients in each group (P = 0.77). Mean operative time was 155 ± 80 minutes for stainless steel versus 118 ± 67 minutes for titanium (P = 0.06).
Conclusion: In distal femur fractures, titanium plate removal is not associated with increased technical difficulty compared with stainless steel implants.
        Level of evidence: III
Keywords
Distal femur
Hardware removal
Locking compression plate
Stainless steel
Titanium
Subjects

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The Archives of Bone and Joint Surgery
Volume 14, Issue 4
April 2026
Pages 307-312

  • Receive Date 07 January 2025
  • Revise Date 31 May 2025
  • Accept Date 01 June 2025