Issue

Orthopaedic implants, including intramedullary nails and plate and screw constructs, are commonly used for internal fixation to stabilize fractures and skeletal pathologies. Implant removal is a frequent surgical procedure, with an estimated rate of 180 procedures per 100,000 person years in Western countries. However, the decision to retain or remove implants after fulfilling their intended purpose presents a dilemma, as both options have associated risk and benefits. Currently, there is a lack of both prospective clinical outcome data regarding implant removal or retention, but also a paucity of research evaluating preferences, perspectives, expectations, and experiences, which could aid in optimizing surgical decision-making and ultimately improve outcomes for patients and surgeons considering implant removal.

Objectives

Primary Objectives:

1. To assess patient-reported outcome measures before and after implant removal to evaluate patients' quality of life, pain levels, and functional recovery, including time away for work, and frequency of re-opening WCB claims for implant removal surgery.

2. To report on complication rates following implant removal and to quantify delays in return to work.

3. To evaluate the cost-effectiveness of implant removal compared with implant retention, including direct and indirect costs associated with re-opening WCB claims for implant removal surgery.

Secondary Objectives:

1. Explore patients' experiences, preferences, and perceptions regarding implant removal, including factors influencing their decision-making process, concerns, and post-operative expectations using a locally developed, novel survey (REMOVE survey).

2. Explore surgeons' experiences, preferences, and perceptions regarding implant removal, including factors influencing their decision-making.

Anticipated Results

This research aims to improve surgical decision-making and patient outcomes, specifically in the context of Albertans recovering from traumatic injuries requiring surgical fixation and the use of implants. By examining the controversial topic of implant retention versus removal in multiple ways, our study has the potential to significantly impact key WCB stakeholders, including injured workers, employers, and healthcare providers.